Provider Demographics
NPI:1205908811
Name:ILKIW, ALEXANDRA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:ILKIW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7447 W. TALCOTT AVE.
Mailing Address - Street 2:SUITE #360
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-6082
Mailing Address - Fax:
Practice Address - Street 1:7447 W. TALCOTT AVE.
Practice Address - Street 2:SUITE #360
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-042994207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12383Medicare UPIN
0752510001Medicare NSC