Alexandre Derevianko
Alexandre Derevianko is a Surgical Assistant in Great Lakes, Illinois. Licensed in Illinois. Registered with an NPI since 2014.
- Licensed in
- IL
- In the registry since
- 2014
Practice location Address checks out
1811 Arkansas AveGreat Lakes, IL 60088-4244
Phone: (401) 480-9807
Fax: (847) 733-5827
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Surgical Assistant (primary) | Taxonomy 246ZC0007X · Licence 238000408 (IL) |
|---|
Record details
| NPI number | 1679987879 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | June 16, 2014 |
| Last updated in NPPES | June 19, 2014 |
| Mailing address | 1811 Arkansas Ave, Great Lakes, IL 60088-4244 |