MEDICARE: EXPRESS HEALTHCARE INC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	036110569	IL

General Provider Information

NPI Number	:	1134541568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1502 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5236
Country	:	US
Telephone Number	:	312-243-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5236
Country	:	US
Telephone Number	:	312-243-4840
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEKSANDR GOLDVEKHT
Credential	:
Telephone Number	:	312-243-4840

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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Directions to “EXPRESS HEALTHCARE INC ” Practice Location

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