Provider Demographics
NPI:1942822259
Name:ZLATANOV, STEFAN (MD)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:
Last Name:ZLATANOV
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 1:4001 N 3RD STREET SUITE 290
Mailing Address - Street 2:CREIGHTON UNIVERSITY
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2997
Practice Address - Country:US
Practice Address - Phone:907-205-9364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2024-03-29
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-01-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK204347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program