MEDICARE: DR. OLEG MINKEVITCH M.D.

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	207Q00000X	Family Medicine Physician	036114918	IL

General Provider Information

NPI Number	:	1700816477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLEG MINKEVITCH M.D.

Provider Business Mailing Address
First Line	:	2643 W RICE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4541
Country	:	US
Telephone Number	:	773-865-3567
Fax Number	:	773-435-6461

Provider Business Practice Location Address
First Line	:	2643 W RICE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4541
Country	:	US
Telephone Number	:	773-865-3567
Fax Number	:	773-865-3567

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	11/18/2014

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