Provider Demographics
NPI:1134415979
Name:SEREMBYTSKY, IRYNA (MD)
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:SEREMBYTSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 E BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2152
Mailing Address - Country:US
Mailing Address - Phone:708-442-7174
Mailing Address - Fax:
Practice Address - Street 1:366 E BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2152
Practice Address - Country:US
Practice Address - Phone:708-442-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.059087390200000X
IL036136127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program