| Village Doctor, Ltd | |
|
809 N Western Ave Chicago IL 60622-4637 | |
| (773) 276-8600 | |
| (773) 276-8601 |
| Full Name | Village Doctor, Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 809 N Western Ave, Chicago, Illinois |
| Authorized Official Name and Position | Iouri Melnik (PRESIDENT) |
| Authorized Official Contact | 7732768600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Doctor, Ltd 809 N Western Ave Chicago IL 60622-4637 Ph: (773) 276-8600 | Village Doctor, Ltd 809 N Western Ave Chicago IL 60622-4637 Ph: (773) 276-8600 |
| NPI Number | 1982814992 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6608964622 |
|---|---|
| Medicare Enrollment ID | O20071108000451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982814992 | NPI | - | NPPES |
| 01632565 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Illinois) | Primary |
| Provider Name | Iouri Melnik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235113747 PECOS PAC ID: 6709974728 Enrollment ID: I20071108000440 |
| Provider Name | Olga Saletska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720451099 PECOS PAC ID: 0749586337 Enrollment ID: I20160308001240 |
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