Provider Demographics
NPI:1821227588
Name:TRUKHACHEVA, ELENA VALERY (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:VALERY
Last Name:TRUKHACHEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 W 22ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1245
Mailing Address - Country:US
Mailing Address - Phone:630-954-0054
Mailing Address - Fax:630-954-0064
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1245
Practice Address - Country:US
Practice Address - Phone:630-954-0054
Practice Address - Fax:630-954-0064
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.116050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist