Individual
SAMUEL DOREVITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
75 REMITTANCE DR, SUITE 1951, CHICAGO, IL 60675-1001
(847) 535-5917
(847) 535-5801
Mailing address
5336 N LAKEWOOD AVE, CHICAGO, IL 60640-2209
(773) 334-9029
(312) 996-0064
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
36083148
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36083148
—
IL
Enumeration date
12/22/2005
Last updated
07/08/2007
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