Individual
ILLYA DANILCHEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 200, FORT WAYNE, IN 46845-1714
(260) 425-6030
(260) 425-6028
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000074A
IN
Other
Enumeration date
11/20/2020
Last updated
03/08/2021
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