Healthcare Provider Details

I. General information

NPI: 1013310606
Provider Name (Legal Business Name): VITALIY ALEXANDER VULYKH APN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E. BRUSH HILL RD. DEPARTMENT OF ANESTHESIA
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-3521
  • Fax: 331-221-3827
Mailing address:
  • Phone: 331-221-3521
  • Fax: 331-221-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209011848
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: