Provider Demographics
NPI:1093872822
Name:NIKOLOV, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NIKOLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 LAKESHORE DIVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIREI
Mailing Address - State:WI
Mailing Address - Zip Code:53158
Mailing Address - Country:US
Mailing Address - Phone:708-275-3703
Mailing Address - Fax:
Practice Address - Street 1:1425 N RANDALL RD DEPT OF
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2300
Practice Address - Country:US
Practice Address - Phone:847-742-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155769207L00000X
IL036092238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092238 2Medicaid
IL050075664OtherRAILROAD MEDICARE
IL131983700OtherUS DEPT OF LABOR WC
IL0161919966OtherBLUE SHIELD