Provider Demographics
NPI:1598719213
Name:BUKHALO, YURIY (MD)
Entity Type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:BUKHALO
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 1:1140 PFINGSTEN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2521
Mailing Address - Country:US
Mailing Address - Phone:847-962-4187
Mailing Address - Fax:847-255-4344
Practice Address - Street 1:880 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-255-0900
Practice Address - Fax:847-255-4344
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105460207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105460Medicaid
IL036105460Medicaid
ILK45461Medicare PIN
ILH95959Medicare UPIN