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General NPI Number Information
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NPI Number | 1619605904
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Entity Type | Individual
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Provider Name | NELI NIKOLOV MD
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Gender | Female
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 120 W 7TH ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3834
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Country | US
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Telephone | 800-846-8365
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Fax |
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Provider Business Mailing Address
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Address Line | 918 NORWOOD RD
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City | JANESVILLE
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State | WI
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Zip | 53545-0839
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Country | US
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Telephone | 608-302-1003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0
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License Number State | PA
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