Provider Demographics
NPI:1538275508
Name:SEREMBYTSKY, YURIY
Entity type:Individual
Prefix:
First Name:YURIY
Middle Name:
Last Name:SEREMBYTSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11255 W PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3735
Mailing Address - Country:US
Mailing Address - Phone:708-420-3203
Mailing Address - Fax:
Practice Address - Street 1:11255 W PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525-3735
Practice Address - Country:US
Practice Address - Phone:708-420-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000044246ZS0410X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538275508OtherSURGICAL ASSISTANT