Alexandre Derevianko
NPI #1679987879 in Great Lakes, Illinois
Provider Information
- NPI Number
- 1679987879
- Entity Type
- Individual
- Name
- Alexandre Derevianko
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Specialist/Technologist, Other - Surgical Assistant
- Enumeration Date
- Jun 16, 2014
- Last Updated
- Jun 19, 2014
Practice Location
- Address
- 1811 ARKANSAS AVE
- City
- Great Lakes
- State
- Illinois
- ZIP Code
- 60088-4244
- Phone
- (401) 480-9807
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist/Technologist, Other - Surgical Assistant — Surgical Assistant |
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