Provider Demographics
NPI:1447302104
Name:YALOVETSKIY, VADIM (CSA)
Entity type:Individual
Prefix:MR
First Name:VADIM
Middle Name:
Last Name:YALOVETSKIY
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 GREENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4572
Mailing Address - Country:US
Mailing Address - Phone:847-904-7315
Mailing Address - Fax:847-904-7285
Practice Address - Street 1:ASCENSION ALEXIAN BROTHER MEDICAL CENTER
Practice Address - Street 2:800 BIESTERFIELD RD
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:847-904-7285
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000018246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant