Provider Demographics
NPI:1154309755
Name:GOLDVEKHT, IRINA (DO)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:GOLDVEKHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MCHENRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6705
Mailing Address - Country:US
Mailing Address - Phone:847-618-0351
Mailing Address - Fax:847-618-0766
Practice Address - Street 1:15 S MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6705
Practice Address - Country:US
Practice Address - Phone:847-618-0351
Practice Address - Fax:847-618-0766
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107264Medicaid
H86914Medicare UPIN
ILL99357Medicare ID - Type Unspecified