MEDICARE: DR. KONSTANTIN UMANSKIY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	01095972A	IN
2	208C00000X	Colon & Rectal Surgery Physician	036117911	IL

General Provider Information

NPI Number	:	1033310909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KONSTANTIN UMANSKIY MD

Provider Business Mailing Address
First Line	:	150 HARVESTER DR STE 300
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 5095
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-2026
Fax Number	:	773-834-1995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/18/2025

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