1. Home
  2. Directory
  3. Illinois
  4. Great Lakes
  5. Specialist Technologist Other
  6. NPI Profile

ALEXANDRE DEREVIANKO
NPI 1679987879
Specialist/Technologist, Other - Surgical Assistant in Great Lakes, IL

Active since June 16, 2014
1811 ARKANSAS AVE, GREAT LAKES, IL 60088(401) 480-9807(847) 733-5827 Get Directions Write a Review

NPPES record last updated: June 19, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Alexandre Derevianko NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALEXANDRE DEREVIANKO (NPI 1679987879) is an individual surgical assistant in Great Lakes, Illinois, licensed in Illinois (238000408) and active in the NPI registry since June 2014.

NPPES Registry Identity

NPI1679987879
Entity TypeIndividualMale
Primary Taxonomy246ZC0007X
Provider Legal NameALEXANDRE DEREVIANKO
Location Address1811 ARKANSAS AVEGreat Lakes, IL 60088-4244
Mailing Address1811 Arkansas AveGreat Lakes, IL 60088-4244 · (401) 480-9807 · Fax (847) 733-5827
Phone(401) 480-9807
Fax(847) 733-5827
Sole ProprietorNo
Enumeration DateJune 16, 2014
Last NPPES UpdateJune 19, 2014
✔ NPI 1679987879 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialist/Technologist, Other · Surgical AssistantTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code246ZC0007X
License✔ Licensed in IL · 238000408
Definition
A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in hemostasis and volume replacement. Surgical assistants are certified and registered or licensed by the state, or, in states without licensure, certified as surgical assistants by completing appropriate education and training.
1811 ARKANSAS AVE, Great Lakes, IL 60088
Open in Google Maps ↗

Other Identifiers 1

Other238000408IL · License Number

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alexandre Derevianko's NPI number?

The NPI number for Alexandre Derevianko is 1679987879. It was assigned to this individual provider in the NPPES registry on June 16, 2014.

Where is Alexandre Derevianko located?

Alexandre Derevianko practices at 1811 Arkansas Ave, Great Lakes, IL 60088. The listed phone number is (401) 480-9807.

What is Alexandre Derevianko's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, Other, specializing in Surgical Assistant, with taxonomy code 246ZC0007X.

When was this NPI record last updated?

The NPPES record for Alexandre Derevianko was last updated on June 19, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.