Organization
IVAN KUKHAR MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN KUKHAR MD (OWNER)
(773) 470-9082
Entity
Organization
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(800) 444-6110
(847) 615-2858
Mailing address
PO BOX 689, LAKE FOREST, IL 60045-0689
(847) 615-2200
(847) 615-2858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036124664
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036124664
IL
208VP0014X
Interventional Pain Medicine Physician
036124664
IL
Other
Enumeration date
07/11/2011
Last updated
05/24/2022
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