Provider Demographics
NPI:1578982112
Name:GOVDYAK, OKSANA
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:GOVDYAK
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-0369
Mailing Address - Country:US
Mailing Address - Phone:815-463-0098
Mailing Address - Fax:815-462-4495
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:815-463-0098
Practice Address - Fax:815-462-4495
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000398246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant