Individual
MLADEN VLADIMIROV GRIGOROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5555
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 852-5666
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
05220
KY
207R00000X
Internal Medicine Physician
Primary
OS19898
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100682680
—
KY
Enumeration date
03/23/2019
Last updated
07/03/2023
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