Provider Demographics
NPI:1164871984
Name:CHERNY, DMITRIY (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:CHERNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DMITRIY
Other - Middle Name:
Other - Last Name:CHERNYAKHOVSKIY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1611 W HARRISON ST STE 510-A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-563-2800
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON ST STE 510A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-563-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-149512207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology