1215984067 NPI number — DANIEL ILTCHEV M.D.

Table of content: DANIEL ILTCHEV M.D. (NPI 1215984067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215984067 NPI number — DANIEL ILTCHEV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILTCHEV
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215984067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6707 POWERS BLVD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44129-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-886-2509
Provider Business Mailing Address Fax Number:
440-886-2547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6707 POWERS BLVD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-886-2509
Provider Business Practice Location Address Fax Number:
440-886-2547
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  23043 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 35081363 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 35081363 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 35081363 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00267687 . This is a "RR" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 2995513 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 247336 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 30074 . This is a "BCBSNE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 290-04-8916 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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