Provider Demographics
NPI:1235392218
Name:KONTSEVYY, BOHDAN (RSA, FNP)
Entity Type:Individual
Prefix:
First Name:BOHDAN
Middle Name:
Last Name:KONTSEVYY
Suffix:
Gender:M
Credentials:RSA, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 N SHERIDAN RD APT 30B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-6856
Mailing Address - Country:US
Mailing Address - Phone:773-510-5063
Mailing Address - Fax:
Practice Address - Street 1:6147 N SHERIDAN RD APT 30B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-6856
Practice Address - Country:US
Practice Address - Phone:773-510-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000087246ZC0007X
IL209019937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty