Provider Demographics
NPI:1306891676
Name:NATKIN, JORY ALAN (DO)
Entity type:Individual
Prefix:
First Name:JORY
Middle Name:ALAN
Last Name:NATKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL RM 1210
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:2050 PFINGSTEN RD
Practice Address - Street 2:SUITE
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1324
Practice Address - Country:US
Practice Address - Phone:847-657-1820
Practice Address - Fax:847-657-1823
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036075701207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C41422Medicare UPIN
460360Medicare ID - Type Unspecified