Provider Demographics
NPI:1942642012
Name:NAGREBETSKY, ALEXANDER (MD MSC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:NAGREBETSKY
Suffix:
Gender:M
Credentials:MD MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 W POLK ST
Mailing Address - Street 2:ROOM SSR 1311B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4891
Mailing Address - Country:US
Mailing Address - Phone:312-662-2708
Mailing Address - Fax:
Practice Address - Street 1:1933 W POLK ST
Practice Address - Street 2:ROOM SSR 1311B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4891
Practice Address - Country:US
Practice Address - Phone:312-662-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063675207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology