Provider Demographics
NPI:1851358600
Name:GEORGIEV, OLEG P (MD)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:P
Last Name:GEORGIEV
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:PO BOX 3471
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0471
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:6709 S. MINNESOTA AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-496-7002
Practice Address - Fax:877-543-8251
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4680207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN021500700Medicaid
IA0535831Medicaid
MN72B66GEOtherBCBS
IA18739OtherBCBS
SD110212900OtherRAILROAD MEDICARE
SD4997593OtherBCBS
SD6630620Medicaid
MN72B66GEOtherBCBS
SDS1007Medicare PIN
IA18739OtherBCBS
SD6630620Medicaid
MN021500700Medicaid