Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036113477 | IL |
N | 208200000X | Surgeon | 036113477 | IL |
N | 208600000X | Surgeon | 036113477 | IL |
NPI | 1568664555 |
---|---|
Provider Name | Ivo Georgiev Tzvetanov |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2007 |
Last Update Date | 18/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036113477 | (05) | IL |
P00753158 | RR (01) | IL |