Provider Demographics
NPI:1073972352
Name:RIVKIN, OLEG
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:RIVKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 OLD GLENVIEW RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2997
Mailing Address - Country:US
Mailing Address - Phone:847-736-4141
Mailing Address - Fax:
Practice Address - Street 1:3305 OLD GLENVIEW RD
Practice Address - Street 2:UNIT C
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2997
Practice Address - Country:US
Practice Address - Phone:847-736-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist