Provider Demographics
NPI:1942291604
Name:POYLIN, VITALIY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:VITALIY
Middle Name:Y
Last Name:POYLIN
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 1:259 E ERIE ST FL 16
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-695-6868
Mailing Address - Fax:312-695-2729
Practice Address - Street 1:259 E ERIE ST FL 16
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-695-6868
Practice Address - Fax:312-695-2729
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225056208C00000X
IL03149083208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery