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Alexandre Derevianko
NPI 1679987879 · on the registry since 2014
Practice
- Address
- 1811 Arkansas Ave
Great Lakes, IL 60088 - Phone
- (401) 480-9807
- Fax
- (847) 733-5827
Registry record
- Primary taxonomy
- Surgical Assistant
246ZC0007X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2014-06-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois