=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760503817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVETA BOYANCHEK MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 S CLAY ST STE 104E
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-929-5186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 S CLAY ST STE 104E
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-929-5186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. IVETA BOYANCHEK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 630-929-5186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------