Healthcare Provider Details

I. General information

NPI: 1992724488
Provider Name (Legal Business Name): ALEXANDER YANOVSKIY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E GOLF RD STE 201
DES PLAINES IL
60016-8821
US

IV. Provider business mailing address

1400 E GOLF RD STE 201
DES PLAINES IL
60016-8821
US

V. Phone/Fax

Practice location:
  • Phone: 847-294-3338
  • Fax: 847-906-1092
Mailing address:
  • Phone: 847-298-3338
  • Fax: 847-298-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016005284
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: