Healthcare Provider Details

I. General information

NPI: 1679198584
Provider Name (Legal Business Name): OLIVIA LOUISE KAMENSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/29/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W HARRISON ST STE 108
CHICAGO IL
60612-3825
US

IV. Provider business mailing address

CHILDREN'S HOSPITAL OUTPATIENT CENTER 14 MEDICAL PARK SUITE 400
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-7802
  • Fax: 312-942-4201
Mailing address:
  • Phone: 803-434-6155
  • Fax: 803-434-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL84412
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.165422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: