Provider Demographics
NPI:1558318980
Name:NIKOLOV, NIKOLAY G (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAY
Middle Name:G
Last Name:NIKOLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E NICOLLET BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4522
Mailing Address - Country:US
Mailing Address - Phone:952-460-4000
Mailing Address - Fax:952-460-4120
Practice Address - Street 1:303 E NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4522
Practice Address - Country:US
Practice Address - Phone:952-460-4000
Practice Address - Fax:952-460-4120
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDA9041034917OtherPREFERRED ONE #
MN1885619OtherAMERICA'S PPO/ARAZ #
MN0405824OtherMEDICA #
MN0408276OtherMEDICA #
MN051G9NIOtherMNBS #
MN23434OtherNDBS #
MNHP39505OtherHEALTHPARTNERS #
MN052G1NIOtherMNBS #
MN052G0NIOtherMNBS #
MN137060OtherUCARE #
MN0405823OtherMEDICA #
MN428990100Medicaid
MN428990100Medicaid
MNHP39505OtherHEALTHPARTNERS #
MN0408276OtherMEDICA #
MN110009338Medicare ID - Type UnspecifiedMN MEDICARE #
MNP00122220Medicare ID - Type UnspecifiedRR MEDICARE #