Healthcare Provider Details

I. General information

NPI: 1770580029
Provider Name (Legal Business Name): GEORGE N ATIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date: 03/20/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

200 FOX GLEN CT
BARRINGTON IL
60010-1809
US

IV. Provider business mailing address

200 FOX GLEN CT
BARRINGTON IL
60010-1809
US

V. Phone/Fax

Practice location:
  • Phone: 847-382-7165
  • Fax: 847-713-8160
Mailing address:
  • Phone: 847-382-7165
  • Fax: 847-713-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036096799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: