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General NPI Number Information
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NPI Number | 1134018989
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Entity Type | Organization
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Legal Business Name | MEDORA LLC
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Dates
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Enumeration Date | 06/28/2025
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Last Update Date | 06/28/2025
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Provider Practice Location Address
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Address Line | 1400 E GOLF RD STE 201
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City | DES PLAINES
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State | IL
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Zip | 60016-8821
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Country | US
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Telephone | 224-676-0462
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Fax | 847-906-1092
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Provider Business Mailing Address
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Address Line | 1400 E GOLF RD STE 201
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City | DES PLAINES
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State | IL
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Zip | 60016-8821
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Country | US
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Telephone | 224-676-0462
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Fax | 847-906-1092
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER YANOVSKIY
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Credential | DPM
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Telephone | 224-676-0462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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