Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3024886 | OH |
NPI | 1205275153 |
---|---|
Provider Name | Ivan Stojanov |
First Address | Cleveland, OH 44103-4273 |
Second Address | Cleveland, OH 44106-3804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 19/01/2017 |