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General NPI Number Information
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NPI Number | 1336329580
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Entity Type | Organization
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Legal Business Name | YEVGENY ODESSKY MDSC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 4860 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60077-2953
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Country | US
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Telephone | 847-329-0470
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Fax | 847-329-0472
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Provider Business Mailing Address
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Address Line | 4860 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60077-2953
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Country | US
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Telephone | 847-329-0470
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Fax | 847-329-0472
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YEVGENY ODESSKY
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Credential |
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Telephone | 847-329-0470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036089618
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License Number State | IL
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