Provider Demographics
NPI:1598152324
Name:SERGEYENKO, ARTEM (MD)
Entity Type:Individual
Prefix:
First Name:ARTEM
Middle Name:
Last Name:SERGEYENKO
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 1:16105 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5503
Mailing Address - Country:US
Mailing Address - Phone:708-636-3757
Mailing Address - Fax:708-636-4361
Practice Address - Street 1:16105 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5503
Practice Address - Country:US
Practice Address - Phone:708-636-3757
Practice Address - Fax:708-636-4361
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.149912207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology