Provider Demographics
NPI:1700025160
Name:BAKALOV, VLADIMIR KOLEV (MD)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:KOLEV
Last Name:BAKALOV
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 1:2777 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8310
Mailing Address - Country:US
Mailing Address - Phone:386-774-2550
Mailing Address - Fax:386-775-0176
Practice Address - Street 1:2777 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8310
Practice Address - Country:US
Practice Address - Phone:386-774-2550
Practice Address - Fax:386-775-0176
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115704207RE0101X
DCMD32243207RE0101X
VA0101261933207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008971700Medicaid
FLHH509ZMedicare PIN