MEDICARE: BOLEVIKA INC

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	246ZC0007X	Surgical Assistant	2380000087	IL

General Provider Information

NPI Number	:	1437534427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLEVIKA INC

Provider Business Mailing Address
First Line	:	6157 N SHERIDAN RD
Second Line	:	APT 17K
City	:	CHICAGO
State	:	IL
Zip	:	60660-3089
Country	:	US
Telephone Number	:	773-510-5063
Fax Number	:

Provider Business Practice Location Address
First Line	:	6157 N SHERIDAN RD
Second Line	:	APT 17K
City	:	CHICAGO
State	:	IL
Zip	:	60660-3089
Country	:	US
Telephone Number	:	773-510-5063
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BOHDAN KONTSEVYY
Credential	:	AS
Telephone Number	:	773-510-5063

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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Directions to “BOLEVIKA INC ” Practice Location

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