Provider Demographics
NPI:1972942258
Name:TABATCHYK, VIKTOR (SA)
Entity Type:Individual
Prefix:
First Name:VIKTOR
Middle Name:
Last Name:TABATCHYK
Suffix:
Gender:M
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FRANK LLOYD WRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2644
Mailing Address - Country:US
Mailing Address - Phone:312-731-5540
Mailing Address - Fax:
Practice Address - Street 1:109 FRANK LLOYD WRIGHT LN
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2644
Practice Address - Country:US
Practice Address - Phone:312-731-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000161246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist