Provider Demographics
NPI:1437540309
Name:BAIDJIEV, ILIAS
Entity Type:Individual
Prefix:
First Name:ILIAS
Middle Name:
Last Name:BAIDJIEV
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 1:12001 CARRINGTON LN APT 205
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6294
Mailing Address - Country:US
Mailing Address - Phone:347-484-2022
Mailing Address - Fax:
Practice Address - Street 1:12001 CARRINGTON LN APT 205
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6294
Practice Address - Country:US
Practice Address - Phone:347-484-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.409786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse