Basic Information
| Provider Information | |||||||||
| NPI: | 1003143801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEOKTISTOV | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 WAUKEGAN RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600932744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739487557 | ||||||||
| FaxNumber: | 7739487558 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 WAUKEGAN RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600932744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739487557 | ||||||||
| FaxNumber: | 7739487558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2009 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036124141 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.