Provider Demographics
NPI:1528208410
Name:MANIKATOV, IVAN ATANASSOV (CSA)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ATANASSOV
Last Name:MANIKATOV
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:520 PEACOCK CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4164
Mailing Address - Country:US
Mailing Address - Phone:630-544-8473
Mailing Address - Fax:630-357-2464
Practice Address - Street 1:520 PEACOCK CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4164
Practice Address - Country:US
Practice Address - Phone:630-544-8473
Practice Address - Fax:630-357-2464
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2023-05-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical