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General NPI Number Information
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NPI Number | 1891113734
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Entity Type | Organization
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Legal Business Name | ALEXANDER TIMCHAK MD LLC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 60 REVERE DR STE 100
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City | NORTHBROOK
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State | IL
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Zip | 60062-1590
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Country | US
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Telephone | 708-207-4580
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Fax |
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Provider Business Mailing Address
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Address Line | 60 REVERE DR STE 100
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City | NORTHBROOK
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State | IL
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Zip | 60062-1590
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Country | US
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Telephone | 708-207-4580
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ALEXANDER M TIMCHAK
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Credential | M.D.
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Telephone | 708-207-4580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 336090545
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 336090545
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License Number State | IL
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