Healthcare Provider Details

I. General information

NPI: 1649800012
Provider Name (Legal Business Name): JOHN DANIEL ATTONITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 04/09/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 ILLINOIS STREET TRANQUILLITY CLINIC - SPECIAL PHYSICALS
GREAT LAKES IL
60088
US

IV. Provider business mailing address

3420 ILLINOIS STREET TRANQUILITY CLINIC - SPECIAL PHYSICALS
GREAT LAKES IL
60088
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-6755
  • Fax: 847-688-2721
Mailing address:
  • Phone: 847-688-6755
  • Fax: 847-688-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.167685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: