Healthcare Provider Details

I. General information

NPI: 1235392218
Provider Name (Legal Business Name): BOHDAN KONTSEVYY RSA, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 N SHERIDAN RD APT 30B
CHICAGO IL
60660-6856
US

IV. Provider business mailing address

6147 N SHERIDAN RD APT 30B
CHICAGO IL
60660-6856
US

V. Phone/Fax

Practice location:
  • Phone: 773-510-5063
  • Fax:
Mailing address:
  • Phone: 773-510-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000087
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019937
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: