Provider Demographics
NPI:1164474318
Name:NIKORB MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:NIKORB MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEADORE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:IVANCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-849-4418
Mailing Address - Street 1:3900 KRESGE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4681
Mailing Address - Country:US
Mailing Address - Phone:502-894-4418
Mailing Address - Fax:502-894-8966
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-894-4418
Practice Address - Fax:502-894-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty