Individual
ALEXANDER WOLODYMYR KMICIKEWYCZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12622 SOUTH HARLEM AVENUE, PALOS HEIGHTS, IL 60463-1428
(708) 923-9610
(708) 923-9613
Mailing address
12622 SOUTH HARLEM AVENUE, PALOS HEIGHTS, IL 60463-1428
(708) 923-9610
(708) 923-9613
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036064794
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31601176
BLUE CROSS BLUE SHIELD IL
—
Enumeration date
08/30/2006
Last updated
12/29/2021
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