Provider Demographics
NPI:1992724488
Name:YANOVSKIY, ALEXANDER (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:YANOVSKIY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E GOLF RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8821
Mailing Address - Country:US
Mailing Address - Phone:847-298-3338
Mailing Address - Fax:847-298-3334
Practice Address - Street 1:1400 E GOLF RD STE 201
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-8821
Practice Address - Country:US
Practice Address - Phone:847-294-3338
Practice Address - Fax:847-906-1092
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005284213ES0103X
IL016005284213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005284Medicaid