Derevianko, Alexandre

Derevianko, Alexandre is an individual health care provider with primary practice located at 1811 Arkansas Ave , Great Lakes IL 60088-4244. He recently has only one registered license in Technologists, Technicians & Other Technical Service Providers / Surgical Assistant, which is considered as his primary health care specialty. Derevianko, Alexandre can be contacted via phone (401) 480-9807.

Contact Information

Primary practice address
1811 Arkansas Ave Great Lakes IL 60088-4244
Phone: (401) 480-9807
Fax: (847) 733-5827
Website:
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Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Surgical Assistant 246ZC0007X 238000408 Illinois

Profile Details

NPI number 1679987879
LBN Legal business name Derevianko, Alexandre
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2014
Last updated Jun 19th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679987879 NPPES
Illinois Other 238000408 LICENSE NUMBER

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