Provider Demographics
NPI:1669639316
Name:GUEORGUIEV, TOMISLAV LUBENOV
Entity Type:Individual
Prefix:
First Name:TOMISLAV
Middle Name:LUBENOV
Last Name:GUEORGUIEV
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 1:628 COBBLESTONE CIR
Mailing Address - Street 2:UNIT B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3843
Mailing Address - Country:US
Mailing Address - Phone:847-530-7033
Mailing Address - Fax:847-827-5259
Practice Address - Street 1:628 COBBLESTONE CIR
Practice Address - Street 2:UNIT B
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3843
Practice Address - Country:US
Practice Address - Phone:847-530-7033
Practice Address - Fax:847-827-5259
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor