Andrew Ivanchenko MD PC
Specialist in Buffalo Grove, IL. Organization (NPI-2).
NPI number1487857421
StatusActive
Last updated in NPPESApr 29, 2024
Details
- NPI
- 1487857421
- Entity type
- Organization (NPI-2)
- Legal business name
- Andrew Ivanchenko MD PC
- Organization subpart
- No
- Enumeration date
- Jun 7, 2007
- Certification date
- Apr 29, 2024
- Last updated
- Apr 29, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 036111777 | IL | Yes |
Other names
- Andrew Ivanchenko MD PC (Former Legal Business Name)
Practice location
985 S. Buffalo Grove RoadBuffalo Grove, IL 60089
Phone 847-681-1161
Mailing address
235 Moraine RdHighland Park, IL 60035-1933
Phone 847-681-1161 · Fax 847-681-1171
Authorized official
Olesya Malloy
Administrator
8476308340
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