=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700807807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEKSANDR GOLDVEKHT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 06/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7235 W APPLETON AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-815-6700
-----------------------------------------------------
Fax | 414-755-1434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 DUNHILL DR
-----------------------------------------------------
City | BUFFALO GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60089-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-530-9317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 36110569
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 01064540A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | P6398
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | P6398
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 2081N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 8211
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------