Healthcare Provider Details

I. General information

NPI: 1669603858
Provider Name (Legal Business Name): ALEKSANDRS U KALNINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE DEPT OF RADIOLOGY
EVANSTON IL
60201-1057
US

IV. Provider business mailing address

2650 RIDGE AVE DEPT OF RADIOLOGY
EVANSTON IL
60201-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2486
  • Fax:
Mailing address:
  • Phone: 847-570-2475
  • Fax: 847-570-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number036141662
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301094847
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036141662
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036141662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: