Provider Demographics
NPI:1679341648
Name:SIMEONOVSKI, ANDREY VELIZAROV (DPT)
Entity type:Individual
Prefix:
First Name:ANDREY
Middle Name:VELIZAROV
Last Name:SIMEONOVSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2522
Mailing Address - Country:US
Mailing Address - Phone:312-380-1822
Mailing Address - Fax:
Practice Address - Street 1:1520 N DAYTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2522
Practice Address - Country:US
Practice Address - Phone:312-380-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027987208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation