Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036085403 | IL |
NPI | 1023028750 |
---|---|
Provider Name | Dr. Nestor M Ivkov |
First Address | Palos Heights, IL 60463-1055 |
Second Address | Palos Heights, IL 60463-1055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036085403 | (05) | IL |
H20600 | (02) | IL |