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General NPI Number Information
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NPI Number | 1093771263
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Entity Type | Organization
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Legal Business Name | CORDIAL MEDICAL CENTER, S.C.
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 08/13/2023
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Provider Practice Location Address
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Address Line | 333 E IL ROUTE 83 STE 105
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City | MUNDELEIN
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State | IL
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Zip | 60060-4278
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Country | US
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Telephone | 847-970-9922
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Fax | 847-970-9955
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Provider Business Mailing Address
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Address Line | 333 E IL ROUTE 83 STE 105
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City | MUNDELEIN
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State | IL
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Zip | 60060-4278
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Country | US
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Telephone | 847-970-9922
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Fax | 847-970-9955
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKHAIL KHODARKOVSKIY
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Credential | M.D.
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Telephone | 224-392-3643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-107538
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License Number State | IL
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