MEDICARE: NIKOLAY G DELEV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1720277387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLAY G DELEV M.D.

Provider Business Mailing Address
First Line	:	856 W NELSON ST.
Second Line	:	# 503
City	:	CHICAGO
State	:	IL
Zip	:	60657-5101
Country	:	US
Telephone Number	:	571-331-0899
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 W WELLINGTON AVE
Second Line	:	ROOM 7304
City	:	CHICAGO
State	:	IL
Zip	:	60657-5193
Country	:	US
Telephone Number	:	773-296-7046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	10/19/2007

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