Healthcare Provider Details

I. General information

NPI: 1578941753
Provider Name (Legal Business Name): JONATAN HORNIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date: 12/16/2015
Reactivation Date: 01/06/2016

III. Provider practice location address

305 W JACKSON ST STE 103
CARBONDALE IL
62901-1474
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-351-4972
  • Fax: 618-351-6522
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTP335
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036149817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: