Provider Demographics
NPI:1740672963
Name:TODOROV, BORIS KRASIMIROV (PHD)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:KRASIMIROV
Last Name:TODOROV
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SKOKIE BLVD
Mailing Address - Street 2:STE 245
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7932
Mailing Address - Country:US
Mailing Address - Phone:847-686-0090
Mailing Address - Fax:847-686-0090
Practice Address - Street 1:500 BURLINGTON RD
Practice Address - Street 2:SUITE 240
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9360
Practice Address - Country:US
Practice Address - Phone:740-286-5075
Practice Address - Fax:740-395-8411
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200820Medicaid