Healthcare Provider Details

I. General information

NPI: 1487580643
Provider Name (Legal Business Name): SVIATOSLAV TSEBRYK RSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19015 S JODI RD STE H
MOKENA IL
60448-8534
US

IV. Provider business mailing address

19015 S JODI RD STE H
MOKENA IL
60448-8534
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-5418
  • Fax: 832-804-8886
Mailing address:
  • Phone: 708-995-5418
  • Fax: 832-804-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number238010984
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: