Individual
YEKATERINA FAYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 E LOCUST ST, OLNEY, IL 62450-2553
(618) 392-1139
(618) 392-1138
Mailing address
800 E LOCUST ST, OLNEY, IL 62450-2553
(618) 392-1139
(618) 392-1138
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01069692A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
036117305
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036117305
STATE LICENSE
IL
05
—
036117305
—
IL
01
—
1699934471
NPI NUMBER
IL
05
—
201025070
—
IN
01
—
336078451
CONTROLLED SUBSTANCE LICENSE
IL
01
—
F400434935
MEDICARE NUMBER
IL
Enumeration date
06/05/2008
Last updated
11/17/2023
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