Provider Demographics
NPI:1184770208
Name:TSYRULNIKOV, YEVGENY (MD)
Entity type:Individual
Prefix:
First Name:YEVGENY
Middle Name:
Last Name:TSYRULNIKOV
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 1:2140 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6421
Mailing Address - Country:US
Mailing Address - Phone:773-506-4695
Mailing Address - Fax:773-564-6095
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:4BLUM
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-506-4695
Practice Address - Fax:773-564-6095
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL425350Medicare ID - Type Unspecified
ILG07482Medicare UPIN