# IVAN KUKHAR MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639467749
- **Authorized official:** DR. IVAN KUKHAR MD (OWNER)
- **Authorized official phone:** (773) 470-9082

## Contact information

- **Practice address:** 2701 17TH ST, ROCK ISLAND, IL 61201-5351
- **Practice address phone:** (800) 444-6110
- **Practice address fax:** (847) 615-2858
- **Mailing address:** PO BOX 689, LAKE FOREST, IL 60045-0689
- **Mailing address phone:** (847) 615-2200
- **Mailing address fax:** (847) 615-2858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 036124664 | IL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 036124664 | IL | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | 036124664 | IL | — |

## Other

- **Enumeration date:** 07/11/2011
- **Last updated:** 05/24/2022