Provider Demographics
NPI:1063403665
Name:SLUTSKY, JOEL N (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:N
Last Name:SLUTSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:STE P530
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-937-4006
Mailing Address - Fax:815-937-3850
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:STE P530
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-937-4006
Practice Address - Fax:815-937-3850
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4600208OtherBLUE CROSS BLUE SHIELD
ILL15643Medicare UPIN
ILL28009Medicare UPIN
ILL53752Medicare UPIN
IL4600208OtherBLUE CROSS BLUE SHIELD