Provider Demographics
NPI:1437534427
Name:BOLEVIKA INC
Entity Type:Organization
Organization Name:BOLEVIKA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOHDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONTSEVYY
Authorized Official - Suffix:
Authorized Official - Credentials:AS
Authorized Official - Phone:773-510-5063
Mailing Address - Street 1:6157 N SHERIDAN RD
Mailing Address - Street 2:APT 17K
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3089
Mailing Address - Country:US
Mailing Address - Phone:773-510-5063
Mailing Address - Fax:
Practice Address - Street 1:6157 N SHERIDAN RD
Practice Address - Street 2:APT 17K
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3089
Practice Address - Country:US
Practice Address - Phone:773-510-5063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2380000087246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty