Healthcare Provider Details

I. General information

NPI: 1891113734
Provider Name (Legal Business Name): ALEXANDER TIMCHAK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 708-207-4580
  • Fax:
Mailing address:
  • Phone: 708-207-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336090545
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number336090545
License Number StateIL

VIII. Authorized Official

Name: DR. ALEXANDER M TIMCHAK
Title or Position: MANAGER
Credential: M.D.
Phone: 708-207-4580