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General NPI Number Information
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NPI Number | 1437534427
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Entity Type | Organization
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Legal Business Name | BOLEVIKA INC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 6157 N SHERIDAN RD APT 17K
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City | CHICAGO
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State | IL
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Zip | 60660-3089
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Country | US
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Telephone | 773-510-5063
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Fax |
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Provider Business Mailing Address
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Address Line | 6157 N SHERIDAN RD APT 17K
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City | CHICAGO
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State | IL
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Zip | 60660-3089
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Country | US
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Telephone | 773-510-5063
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOHDAN KONTSEVYY
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Credential | AS
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Telephone | 773-510-5063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 2380000087
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License Number State | IL
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