| A Podolskiy Md Sc | |
|
755 S Milwaukee Ave Suite 164 Libertyville IL 60048-3253 | |
| (847) 918-0430 | |
| Not Available |
| Full Name | A Podolskiy Md Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 755 S Milwaukee Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Aleksandr Podolskiy (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8479180430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Podolskiy Md Sc Po Box 5979 Buffalo Grove IL 60089-5979 Ph: (847) 918-0430 | A Podolskiy Md Sc 755 S Milwaukee Ave Suite 164 Libertyville IL 60048-3253 Ph: (847) 918-0430 |
| NPI Number | 1578634168 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 05/14/2013 |
| Medicare PECOS PAC ID | 5496768285 |
|---|---|
| Medicare Enrollment ID | O20060721000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578634168 | NPI | - | NPPES |
| 036111753 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036111753 (Illinois) | Primary |
| Provider Name | Aleksandr Podolskiy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619922135 PECOS PAC ID: 7810957321 Enrollment ID: I20041018001126 |
| Provider Name | Reena V Blesson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619221900 PECOS PAC ID: 1557507159 Enrollment ID: I20130427000133 |
| Provider Name | Brianna M Wicinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508415951 PECOS PAC ID: 7214269158 Enrollment ID: I20191028000203 |
| Provider Name | Galina Shvayetskaya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164017034 PECOS PAC ID: 3678980406 Enrollment ID: I20210323002381 |
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