# ICOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649863986
- **Authorized official:** LUDMIL LAZAROV MD (OWNER)
- **Authorized official phone:** (773) 715-8034

## Contact information

- **Practice address:** 5926 N SANTA MONICA BLVD, MILWAUKEE, WI 53217-4618
- **Practice address phone:** (773) 715-8034
- **Mailing address:** 5926 N SANTA MONICA BLVD, MILWAUKEE, WI 53217-4618

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/18/2021
- **Last updated:** 04/15/2021