Individual
IVAN IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1516 FRANKLIN AVE, RIVER FOREST, IL 60305-1043
(773) 909-3741
Mailing address
1516 FRANKLIN AVE, RIVER FOREST, IL 60305-1043
(773) 909-3741
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
336058
NY
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
336058
NY
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/24/2020
Last updated
05/05/2026
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