Provider Demographics
NPI:1053912782
Name:POPOV, ARTHUR
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:POPOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 DILLON CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3374
Mailing Address - Country:US
Mailing Address - Phone:847-849-6959
Mailing Address - Fax:
Practice Address - Street 1:732 DILLON CT
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3374
Practice Address - Country:US
Practice Address - Phone:847-849-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver