Provider Demographics
NPI:1881644565
Name:KOLEZEVA, YELENA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:Y
Last Name:KOLEZEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YELENA
Other - Middle Name:Y
Other - Last Name:KOLEZEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4709 GOLF RD STE 900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1244
Mailing Address - Country:US
Mailing Address - Phone:847-676-5394
Mailing Address - Fax:847-679-7183
Practice Address - Street 1:4709 GOLF RD STE 900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1244
Practice Address - Country:US
Practice Address - Phone:847-676-5394
Practice Address - Fax:847-679-7183
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics