Healthcare Provider Details

I. General information

NPI: 1851228357
Provider Name (Legal Business Name): GARY AKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 S CHAMPLAIN AVE APT 3S
CHICAGO IL
60653-2691
US

IV. Provider business mailing address

4228 S CHAMPLAIN AVE APT 3S
CHICAGO IL
60653-2691
US

V. Phone/Fax

Practice location:
  • Phone: 773-512-3372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.1111.94
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: