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General NPI Number Information
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NPI Number | 1801091582
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Entity Type | Organization
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Legal Business Name | ALEKSANDR DEKHTYAR MD SC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 614 MARTIN LN
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City | DEERFIELD
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State | IL
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Zip | 60015-3633
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Country | US
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Telephone | 224-805-6085
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Fax |
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Provider Business Mailing Address
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Address Line | 614 MARTIN LN
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City | DEERFIELD
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State | IL
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Zip | 60015-3633
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Country | US
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Telephone | 224-805-6085
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | ALEKSANDR DEKHTYAR
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Credential | MD
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Telephone | 224-805-6085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036110249
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License Number State | IL
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