MEDICARE: LYUBOV ANDRUSHKIV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist	238000291	IL

General Provider Information

NPI Number	:	1316280514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUBOV ANDRUSHKIV

Provider Business Mailing Address
First Line	:	840 N OAKLEY BLVD APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4735
Country	:	US
Telephone Number	:	773-733-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 N OAKLEY BLVD APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4735
Country	:	US
Telephone Number	:	773-733-8056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	04/05/2013

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Directions to “ LYUBOV ANDRUSHKIV ” Practice Location

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