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NPI Code Detail

MEDICARE: VLADIMIR A LYTCHAKOV MD

MEDICARE: VLADIMIR A LYTCHAKOV 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
1207R00000XInternal Medicine Physician37260KY
2207R00000XInternal Medicine Physician036121326IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1R02387OTHERILMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184617201
Entity Type Code : Individual
Provider Name (Legal Business Name) : VLADIMIR A LYTCHAKOV MD
Provider Business Mailing Address
First Line : 1025 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2403
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 1025 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2403
Country : US
Telephone Number : 217-528-7541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 05/21/2020

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Directions to “ VLADIMIR A LYTCHAKOV MD” Practice Location

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