Healthcare Provider Details

I. General information

NPI: 1508057373
Provider Name (Legal Business Name): OLGA GORENYUK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 HALIGUS RD
HUNTLEY IL
60142-9553
US

IV. Provider business mailing address

925 SHERWOOD DR
LAKE BLUFF IL
60044-2203
US

V. Phone/Fax

Practice location:
  • Phone: 224-654-0000
  • Fax: 224-654-0000
Mailing address:
  • Phone: 847-615-2200
  • Fax: 847-615-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0065836
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036128629
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036128629
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125052811
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: