Provider Demographics
NPI:1508960816
Name:TSIPURSKY, SVETLANA
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:TSIPURSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 GOLF RD
Mailing Address - Street 2:ST 120
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-724-0101
Mailing Address - Fax:847-724-7412
Practice Address - Street 1:2640 GOLF RD
Practice Address - Street 2:ST 120
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-724-0101
Practice Address - Fax:847-724-7412
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL547760Medicare PIN
ILG51718Medicare UPIN
IL4168450001Medicare NSC