MEDICARE: OLEG V. KOROLEV 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	207L00000X	Anesthesiology Physician	036103607	IL

General Provider Information

NPI Number	:	1750383535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLEG V. KOROLEV M.D.

Provider Business Mailing Address
First Line	:	68 S. SERVICE RD.
Second Line	:	STE 350
City	:	MELVILLE
State	:	NY
Zip	:	11747-2358
Country	:	US
Telephone Number	:	516-945-3351
Fax Number	:	516-945-3131

Provider Business Practice Location Address
First Line	:	3 ERIE CT
Second Line	:	WESTLAKE HOSPITAL / ANESTHESIA DEPARTMENT
City	:	OAK PARK
State	:	IL
Zip	:	60302-2519
Country	:	US
Telephone Number	:	708-524-9130
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/03/2014

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