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General NPI Number Information
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NPI Number | 1134541568
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Entity Type | Organization
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Legal Business Name | EXPRESS HEALTHCARE INC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 1502 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60642-5236
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Country | US
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Telephone | 312-243-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60642-5236
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Country | US
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Telephone | 312-243-4840
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEKSANDR GOLDVEKHT
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Credential |
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Telephone | 312-243-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036110569
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License Number State | IL
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