1154872174 NPI number — YEVGEN TKACHUK DDS PC

Table of content: (NPI 1154872174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154872174 NPI number — YEVGEN TKACHUK DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YEVGEN TKACHUK DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154872174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4238 N BLOOMINGTON AVE
Provider Second Line Business Mailing Address:
203
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60004-8310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 E DUNDEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-4383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-229-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TKACHUK
Authorized Official First Name:
YEVGEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST OWNER
Authorized Official Telephone Number:
312-544-9384

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019029513 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)