Provider Demographics
NPI:1790560613
Name:NEDELTCHEVA, ARLET (MD)
Entity Type:Individual
Prefix:DR
First Name:ARLET
Middle Name:
Last Name:NEDELTCHEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ARLET
Other - Middle Name:
Other - Last Name:PENEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2150 SHERMAN AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2860
Mailing Address - Country:US
Mailing Address - Phone:312-405-2512
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-405-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 171M00000X, 171R00000X, 172V00000X, 1744R1103X, 174H00000X, 251S00000X, 261QC1500X, 261QR1100X, 332B00000X, 332BC3200X, 390200000X, 1744R1102X
IL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter
No172V00000XOther Service ProvidersCommunity Health Worker
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No174H00000XOther Service ProvidersHealth Educator
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program