Provider Demographics
NPI:1346325404
Name:NUTENKO, VICTOR E (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:E
Last Name:NUTENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 W OAKTON STR
Mailing Address - Street 2:OAKTON HEALTH CENTER
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-329-0470
Mailing Address - Fax:847-329-0472
Practice Address - Street 1:4860 W OAKTON STR
Practice Address - Street 2:OAKTON HEALTH CENTER
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2953
Practice Address - Country:US
Practice Address - Phone:847-329-0470
Practice Address - Fax:847-329-0472
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360873122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087312Medicaid
211775OtherMC
IL21621435OtherBLUE CROSS
IL21621435OtherBLUE CROSS
211775OtherMC