Individual
MR. ANDREW IVANCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
985 S. BUFFALO GROVE ROAD, BUFFALO GROVE, IL 60089
(847) 681-1161
(847) 681-1161
Mailing address
235 MORAINE RD, HIGHLAND PARK, IL 60202-2374
(224) 628-0295
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36111777
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
36111777
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111777
—
IL
Enumeration date
08/11/2005
Last updated
06/19/2024
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