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1700807807

NPI Code Detail

MEDICARE: ALEKSANDR GOLDVEKHT MD

MEDICARE: ALEKSANDR GOLDVEKHT 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	36110569	IL
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	01064540A	IN
3	208100000X	Physical Medicine & Rehabilitation Physician	P6398	TX
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	P6398	TX
5	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	8211	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01064540A	OTHER	IN	STATE LICENSE
2	000000557721	OTHER	IN	BLUE CROSS / BLUE SHIELD
3	36110569	OTHER	IL	STATE LICENSE
4	K400108110	OTHER	WI	MC FOR MRT
5	000000564577	OTHER	IN	BLUE CROSS / BLUE SHIELD
6	57560	OTHER	WI	WISCONSIN LICENSE

General Provider Information

NPI Number	:	1700807807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSANDR GOLDVEKHT MD

Provider Business Mailing Address
First Line	:	711 DUNHILL DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1514
Country	:	US
Telephone Number	:	847-530-9317
Fax Number	:

Provider Business Practice Location Address
First Line	:	7235 W APPLETON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1932
Country	:	US
Telephone Number	:	414-815-6700
Fax Number	:	414-755-1434

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	06/20/2014

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Directions to “ ALEKSANDR GOLDVEKHT MD” Practice Location

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