Provider Demographics
NPI:1326246356
Name:VLADIMIRSKIY, NATALYA (MD)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:VLADIMIRSKIY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:
Other - Last Name:VLADIMIRSKIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:213 N RACINE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1644
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:1541 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1313
Practice Address - Country:US
Practice Address - Phone:773-250-5222
Practice Address - Fax:773-866-8018
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125048574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400174614OtherMEDICARE PTAN