Provider Demographics
NPI:1114376480
Name:KAMILOV, DONIYOR
Entity Type:Individual
Prefix:
First Name:DONIYOR
Middle Name:
Last Name:KAMILOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17989 E DICKENSON PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-5909
Mailing Address - Country:US
Mailing Address - Phone:720-207-8137
Mailing Address - Fax:
Practice Address - Street 1:17989 E DICKENSON PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-5909
Practice Address - Country:US
Practice Address - Phone:720-207-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB-10047343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)