Provider Demographics
NPI:1598076358
Name:ILIEVA, HRISTELINA S (MD)
Entity Type:Individual
Prefix:
First Name:HRISTELINA
Middle Name:S
Last Name:ILIEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BROADWAY STE 520
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3342
Mailing Address - Country:US
Mailing Address - Phone:816-960-7601
Mailing Address - Fax:816-960-7699
Practice Address - Street 1:909 WALNUT STREET 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3342
Practice Address - Country:US
Practice Address - Phone:215-955-1234
Practice Address - Fax:215-955-6792
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170176342084N0400X
390200000X
PAMD4692672084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program