Basic Information
| Provider Information | |||||||||
| NPI: | 1558318980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIKOLOV | ||||||||
| FirstName: | NIKOLAY | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 E NICOLLET BLVD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553374522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524604000 | ||||||||
| FaxNumber: | 9524604120 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 E NICOLLET BLVD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553374522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524604000 | ||||||||
| FaxNumber: | 9524604120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 10/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 45808 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DA9041034917 | 01 | MN | PREFERRED ONE # | OTHER | 1885619 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | 0405824 | 01 | MN | MEDICA # | OTHER | 0408276 | 01 | MN | MEDICA # | OTHER | 051G9NI | 01 | MN | MNBS # | OTHER | 23434 | 01 | MN | NDBS # | OTHER | HP39505 | 01 | MN | HEALTHPARTNERS # | OTHER | 052G1NI | 01 | MN | MNBS # | OTHER | 052G0NI | 01 | MN | MNBS # | OTHER | 137060 | 01 | MN | UCARE # | OTHER | 0405823 | 01 | MN | MEDICA # | OTHER | 428990100 | 05 | MN | MEDICAID |