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General NPI Number Information
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NPI Number | 1700203064
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Entity Type | Individual
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Provider Name | ILYA LIVSHITS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE # MC2026
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 773-834-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 579A CRANBURY RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5426
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Country | US
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Telephone | 732-390-0040
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Fax | 732-955-8874
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25MA10818600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA10818600
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License Number State | NJ
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