MEDICARE: DR. ALEXANDER NAGREBETSKY M.D. M.SC.

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	125063675	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942642012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER NAGREBETSKY M.D. M.SC.

Provider Business Mailing Address
First Line	:	1933 W POLK ST
Second Line	:	ROOM SSR 1311B
City	:	CHICAGO
State	:	IL
Zip	:	60612-4891
Country	:	US
Telephone Number	:	312-662-2708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 W POLK ST
Second Line	:	ROOM SSR 1311B
City	:	CHICAGO
State	:	IL
Zip	:	60612-4891
Country	:	US
Telephone Number	:	312-662-2708
Fax Number	:

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

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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