Provider Demographics
NPI:1851391155
Name:DEKHTYAR, ALEKSANDR (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:DEKHTYAR
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 1:614 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3633
Mailing Address - Country:US
Mailing Address - Phone:224-489-3888
Mailing Address - Fax:847-728-2101
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 815
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7220
Practice Address - Country:US
Practice Address - Phone:224-489-3888
Practice Address - Fax:847-728-2101
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361102492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100249Medicaid