Organization
LARISSA BERESTENKO MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA BERESTENKO MD (PRESIDENT)
(773) 271-9786
Entity
Organization
Contact information
Practice address
5140 N CALIFORNIA AVE STE 755, CHICAGO, IL 60625-7065
(773) 271-9786
(773) 217-8028
Mailing address
2760 WILSHIRE LN, NORTHBROOK, IL 60062-2631
(773) 271-9786
(773) 271-8028
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036101565
IL
Other
Enumeration date
05/03/2008
Last updated
05/03/2008
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