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Mladen Vladimirov Grigorov

Internal Medicine

Allopathic & Osteopathic Physicians

530 S Jackson St, Louisville, KY 40202-1675

PECOS Enrollment

This provider is enrolled in PECOS as MLADEN GRIGOROV.

Based on the most recent information from CMS, provider Mladen Vladimirov Grigorov is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1336609403
Provider Type
Individual
Full Name
Grigorov, Mladen Vladimirov
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
3/23/2019
Last Updated
7/3/2023

Contact Information

Practice Location

530 S Jackson St, Louisville, KY 40202-1675

(502) 852-5555

Unlisted Fax

Mailing Location

PO Box 909, Louisville, KY 40201-0909

(502) 852-5666

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License OS19898 Florida
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 05220 Kentucky
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 7100682680	Description Medicaid	Issuer Unlisted Kentucky

Mladen Vladimirov Grigorov

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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