LARISSA BERESTENKO MD SC
Ambulatory Health at California Ave, Chicago, IL

License number
Illinois 036101565
Category
Ambulatory Health
Type
Primary Care
Owner
Name: LARISSA BERESTENKO MD
Title: PRESIDENT
Phone: (773) 271-9786
Address
Address 2
5140 N California Ave STE 755, Chicago, IL 60625
2760 Wilshire Ln, Northbrook, IL 60062
National Provider ID: 1598931198
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LARISSA BERESTENKO, M.D., S.C

Chicago, IL 60625

Registration:
Sep 29, 2000
State ID:
61271848
Business type:
DOMESTIC BCA
Expiration:
PERPETUAL
Agent:
Bruce Michael Rafalson,1735 W Smt Ct, Deerfield, IL 60015 (Physical)

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