Organization
A PODOLSKIY MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEKSANDR PODOLSKIY MD (MEDICAL DIRECTOR)
(847) 918-0430
Entity
Organization
Contact information
Practice address
755 S MILWAUKEE AVE, SUITE 164, LIBERTYVILLE, IL 60048-3253
(847) 918-0430
Mailing address
PO BOX 5979, BUFFALO GROVE, IL 60089-5979
(847) 918-0430
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036111753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111753
—
IL
Enumeration date
11/13/2006
Last updated
05/14/2013
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