Provider Demographics
NPI:1699783126
Name:OKNER, JOEL C (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:C
Last Name:OKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-1541
Mailing Address - Country:US
Mailing Address - Phone:866-227-3606
Mailing Address - Fax:773-439-2444
Practice Address - Street 1:550 W FRONTAGE RD STE 3756
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1289
Practice Address - Country:US
Practice Address - Phone:866-227-3606
Practice Address - Fax:773-439-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41488207RC0000X
MO2016014256207RC0000X
WI65565207RC0000X
MI4301114096207RC0000X
IL036079417207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE71198Medicare UPIN
IL211572Medicare ID - Type Unspecified