Healthcare Provider Details

I. General information

NPI: 1710407705
Provider Name (Legal Business Name): DINA SOLOVEYCHIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

3040 PARK PL
EVANSTON IL
60201-1141
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-3540
  • Fax:
Mailing address:
  • Phone: 847-852-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036.160125
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036.160125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: