Healthcare Provider Details

I. General information

NPI: 1205023140
Provider Name (Legal Business Name): ALEXANDER OLEYNIKOV ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 OLD MCHENRY RD SUITE 130A
BUFFALO GROVE IL
60089-1370
US

IV. Provider business mailing address

609 ACADEMY DR
NORTHBROOK IL
60062-2420
US

V. Phone/Fax

Practice location:
  • Phone: 847-223-9494
  • Fax: 847-205-9722
Mailing address:
  • Phone: 847-223-9494
  • Fax: 847-205-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number32952
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number32953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: