Healthcare Provider Details

I. General information

NPI: 1932132123
Provider Name (Legal Business Name): BORIS LELCHUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E STRONG ST SUITE 6
WHEELING IL
60090-2979
US

IV. Provider business mailing address

201 E STRONG ST SUITE 6
WHEELING IL
60090-2979
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-5222
  • Fax: 847-215-5142
Mailing address:
  • Phone: 847-215-5222
  • Fax: 847-215-5142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036089340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: