MEDICARE: YURIY SEREMBYTSKY

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	246ZS0410X	Surgical Technologist	238.000044	IL
2	363AS0400X	Surgical Physician Assistant	238.000044	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538275508	OTHER	IL	SURGICAL ASSISTANT

General Provider Information

NPI Number	:	1538275508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YURIY SEREMBYTSKY

Provider Business Mailing Address
First Line	:	11255 W PLAINFIELD RD
Second Line	:
City	:	INDIAN HEAD PARK
State	:	IL
Zip	:	60525-3735
Country	:	US
Telephone Number	:	708-420-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	11255 W PLAINFIELD RD
Second Line	:
City	:	INDIAN HEAD PARK
State	:	IL
Zip	:	60525-3735
Country	:	US
Telephone Number	:	708-420-3203
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	09/23/2018

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Directions to “ YURIY SEREMBYTSKY ” Practice Location

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