1750514378 NPI number — TATIYANA URBIN, D.C. LTD

Table of content: (NPI 1750514378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750514378 NPI number — TATIYANA URBIN, D.C. LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TATIYANA URBIN, D.C. LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750514378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9801 GROSS POINT RD
Provider Second Line Business Mailing Address:
STE.203
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-1173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-659-1658
Provider Business Mailing Address Fax Number:
847-677-4717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 WAUKEGAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025-5159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-657-1600
Provider Business Practice Location Address Fax Number:
847-657-1601
Provider Enumeration Date:
08/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
URBIN
Authorized Official First Name:
TATIYANA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESEDENT
Authorized Official Telephone Number:
224-659-1658

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  038009006 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01625853 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 038009006 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".