Provider Demographics
NPI:1861491912
Name:OLGA LANSKY MD, SC
Entity Type:Organization
Organization Name:OLGA LANSKY MD, SC
Other - Org Name:WESTERN FOSTER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:I
Authorized Official - Last Name:BRUSILOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-784-1000
Mailing Address - Street 1:5214 N WESTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2589
Mailing Address - Country:US
Mailing Address - Phone:773-784-1000
Mailing Address - Fax:773-784-1398
Practice Address - Street 1:5214 N WESTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2589
Practice Address - Country:US
Practice Address - Phone:773-784-1000
Practice Address - Fax:773-784-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL580560Medicare ID - Type Unspecified