Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 50863-020 | WI |
Y | 207V00000X | Obstetrician & Gynecologist | 63209 | MN |
NPI | 1013132281 |
---|---|
Provider Name | Tzvetan Fatchikov |
First Address | Mankato, MN 56001-4752 |
Second Address | Mankato, MN 56001-4752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 18/09/2020 |