Provider Demographics
NPI:1508066630
Name:POPOV, CHAVDAR TRIFONOV (MD)
Entity Type:Individual
Prefix:
First Name:CHAVDAR
Middle Name:TRIFONOV
Last Name:POPOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TCHAVDAR
Other - Middle Name:TRIFONOV
Other - Last Name:POPOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3271 BLUETT RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1527
Mailing Address - Country:US
Mailing Address - Phone:734-712-2934
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 4015
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-2934
Practice Address - Fax:734-712-1164
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine