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General NPI Number Information
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NPI Number | 1992724488
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Entity Type | Individual
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Provider Name | ALEXANDER YANOVSKIY DPM
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1400 E GOLF RD STE 201
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City | DES PLAINES
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State | IL
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Zip | 60016-8821
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Country | US
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Telephone | 847-294-3338
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Fax | 847-906-1092
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Provider Business Mailing Address
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Address Line | 1400 E GOLF RD STE 201
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City | DES PLAINES
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State | IL
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Zip | 60016-8821
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Country | US
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Telephone | 847-298-3338
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Fax | 847-298-3334
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016.005284
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005284
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License Number State | IL
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