MEDICARE: DR. SVETLANA MIROSHNICHENKO MD

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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1346231651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SVETLANA MIROSHNICHENKO MD

Provider Business Mailing Address
First Line	:	7013 LOREL AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3489
Country	:	US
Telephone Number	:	773-465-6533
Fax Number	:	773-465-6505

Provider Business Practice Location Address
First Line	:	7122 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-2408
Country	:	US
Telephone Number	:	773-465-6533
Fax Number	:	773-465-6505

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/08/2007

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