Provider Demographics
NPI:1346403060
Name:JELIAZKOVA, ZLATKA KOSTADINOVA (MD)
Entity Type:Individual
Prefix:
First Name:ZLATKA
Middle Name:KOSTADINOVA
Last Name:JELIAZKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZLATKA
Other - Middle Name:KOSTADINOVA
Other - Last Name:SIRAKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4360
Mailing Address - Country:US
Mailing Address - Phone:217-477-4714
Mailing Address - Fax:217-444-4965
Practice Address - Street 1:707 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4360
Practice Address - Country:US
Practice Address - Phone:217-477-4714
Practice Address - Fax:217-444-4965
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-127731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics