Provider Demographics
NPI:1235148263
Name:CHICHKOVA, ROSSITZA IAKIMOVA (MD)
Entity Type:Individual
Prefix:
First Name:ROSSITZA
Middle Name:IAKIMOVA
Last Name:CHICHKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSSITZA
Other - Middle Name:IAKIMOVA
Other - Last Name:CHICHKOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12901 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4742
Practice Address - Country:US
Practice Address - Phone:813-974-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME894632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16468OtherBLUE CROSS BLUE SHIELD
FL272965200Medicaid
FLI38840Medicare UPIN
FL272965200Medicaid
FL16468ZMedicare PIN