Provider Demographics
NPI:1134018989
Name:MEDORA LLC
Entity type:Organization
Organization Name:MEDORA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:YANOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:224-676-0462
Mailing Address - Street 1:1400 E GOLF RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8821
Mailing Address - Country:US
Mailing Address - Phone:224-676-0462
Mailing Address - Fax:847-906-1092
Practice Address - Street 1:1400 E GOLF RD STE 201
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-8821
Practice Address - Country:US
Practice Address - Phone:224-676-0462
Practice Address - Fax:847-906-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty