Healthcare Provider Details

I. General information

NPI: 1700807807
Provider Name (Legal Business Name): ALEKSANDR GOLDVEKHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 W APPLETON AVE
MILWAUKEE WI
53216-1932
US

IV. Provider business mailing address

711 DUNHILL DR
BUFFALO GROVE IL
60089-1514
US

V. Phone/Fax

Practice location:
  • Phone: 414-815-6700
  • Fax: 414-755-1434
Mailing address:
  • Phone: 847-530-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number36110569
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number01064540A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberP6398
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP6398
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number8211
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: