Individual
MR. EMMANUEL BOUTCHEKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17709 WILLIAM ST, LANSING, IL 60438-2063
(708) 307-3854
Mailing address
17709 WILLIAM ST, LANSING, IL 60438-2063
(708) 307-3854
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.105922
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043.105922
LICENSE PRACTICAL NURSE
IL
Enumeration date
03/22/2017
Last updated
03/22/2017
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