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General NPI Number Information
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NPI Number | 1386682714
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Entity Type | Organization
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Legal Business Name | A. PODOLSKIY, MD, SC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 755 S MILWAUKEE AVE SUITE 164
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3253
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Country | US
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Telephone | 847-915-1500
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Fax | 847-915-7580
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Provider Business Mailing Address
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Address Line | 755 S MILWAUKEE AVE SUITE 164
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3253
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Country | US
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Telephone | 847-915-1500
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Fax | 847-915-7580
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ALEKSANDR PODOLSKIY
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Credential | MD
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Telephone | 847-918-1500
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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 |
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License Number State | IL
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