Provider Demographics
NPI:1801884283
Name:YALOVETSKIY, IGOR (PA C)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:YALOVETSKIY
Suffix:
Gender:
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:716 S MILWAUKEE AVE FL 2
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3225
Practice Address - Country:US
Practice Address - Phone:847-362-1848
Practice Address - Fax:847-362-3351
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085002256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK09349Medicare ID - Type Unspecified
Q22844Medicare UPIN