Provider Demographics
NPI:1700807807
Name:GOLDVEKHT, ALEKSANDR (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:GOLDVEKHT
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 1:711 DUNHILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1514
Mailing Address - Country:US
Mailing Address - Phone:847-530-9317
Mailing Address - Fax:
Practice Address - Street 1:7235 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1932
Practice Address - Country:US
Practice Address - Phone:414-815-6700
Practice Address - Fax:414-755-1434
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361105692081P2900X
IN01064540A2081P2900X
TXP6398208100000X, 2081P2900X
TX82112081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01064540AOtherSTATE LICENSE
IN000000557721OtherBLUE CROSS / BLUE SHIELD
IL36110569OtherSTATE LICENSE
WIK400108110OtherMC FOR MRT
IN000000564577OtherBLUE CROSS / BLUE SHIELD
WI57560OtherWISCONSIN LICENSE
IN01064540AOtherSTATE LICENSE
IL36110569OtherSTATE LICENSE