Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036.155475 | IL |
NPI | 1649761842 |
---|---|
Provider Name | Dr. Vasyl Hereha |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Chicago, IL 60637-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2018 |
Last Update Date | 24/06/2021 |