Provider Demographics
NPI:1629345723
Name:KACHANOV, OLEKSANDR (MD)
Entity Type:Individual
Prefix:
First Name:OLEKSANDR
Middle Name:
Last Name:KACHANOV
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-225-0378
Mailing Address - Fax:605-225-7919
Practice Address - Street 1:105 S STATE ST
Practice Address - Street 2:STE 113
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4501
Practice Address - Country:US
Practice Address - Phone:605-225-0378
Practice Address - Fax:605-225-7919
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250607312080P0203X
SD98982080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine