Provider Demographics
NPI:1629575972
Name:SUKHANOVA, MADINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MADINA
Middle Name:
Last Name:SUKHANOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S MICHIGAN AVE APT 1513
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2288
Mailing Address - Country:US
Mailing Address - Phone:630-846-6501
Mailing Address - Fax:
Practice Address - Street 1:910 S MICHIGAN AVE APT 1513
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2288
Practice Address - Country:US
Practice Address - Phone:630-846-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2017203247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician