Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 036075701 | IL |
NPI | 1306891676 |
---|---|
Provider Name | Jory Alan Natkin |
First Address | Evanston, IL 60201-1718 |
Second Address | Glenview, IL 60026-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C41422 | (02) |