Provider Demographics
NPI:1942747720
Name:ERMATOV, VOSIT (RSA)
Entity Type:Individual
Prefix:
First Name:VOSIT
Middle Name:
Last Name:ERMATOV
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 BELMONT RD STE 5
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2126
Mailing Address - Country:US
Mailing Address - Phone:630-241-1933
Mailing Address - Fax:832-804-8896
Practice Address - Street 1:6330 BELMONT RD STE 5
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2126
Practice Address - Country:US
Practice Address - Phone:630-241-1933
Practice Address - Fax:832-804-8896
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000530363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical