Provider Demographics
NPI:1215984067
Name:ILTCHEV, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ILTCHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 POWERS BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5455
Mailing Address - Country:US
Mailing Address - Phone:440-886-2509
Mailing Address - Fax:440-886-2547
Practice Address - Street 1:6707 POWERS BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5455
Practice Address - Country:US
Practice Address - Phone:440-886-2509
Practice Address - Fax:440-886-2547
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23043207RP1001X
OH35081363207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00267687OtherRR
OH2995513Medicaid
NE247336OtherMIDLANDS CHOICE
NE30074OtherBCBSNE
NE290-04-8916Medicaid
NE30074OtherBCBSNE
NEI34349Medicare UPIN
NEI34349Medicare UPIN