Provider Demographics
NPI:1871704072
Name:KUKHAR, IVAN BOGDANOVYCH (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:BOGDANOVYCH
Last Name:KUKHAR
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 1:801 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1804
Mailing Address - Country:US
Mailing Address - Phone:309-281-4000
Mailing Address - Fax:
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-281-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-39811207L00000X
IL036124664207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology