Basic Information
| Provider Information | |||||||||
| NPI: | 1942612858 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ILIEV | ||||||||
| FirstName: | ATANAS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 788 SERVICE RD RM B301 | ||||||||
| Address2: | CLINICAL CENTER | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488247049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173535100 | ||||||||
| FaxNumber: | 5174322759 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 JOHN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693731222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101021080 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 5101021080 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.