Provider Demographics
NPI:1770900094
Name:GRAMATIKOV, IVAYLO MILTCHOV (FNP)
Entity type:Individual
Prefix:
First Name:IVAYLO
Middle Name:MILTCHOV
Last Name:GRAMATIKOV
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2705
Mailing Address - Country:US
Mailing Address - Phone:847-260-5532
Mailing Address - Fax:847-260-5721
Practice Address - Street 1:9518 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2705
Practice Address - Country:US
Practice Address - Phone:847-260-5532
Practice Address - Fax:847-260-5721
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily