Healthcare Provider Details

I. General information

NPI: 1740570696
Provider Name (Legal Business Name): VLADIMIR URBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 GROSS POINT RD STE 107
SKOKIE IL
60076-1264
US

IV. Provider business mailing address

9631 GROSS POINT RD STE 107
SKOKIE IL
60076-1264
US

V. Phone/Fax

Practice location:
  • Phone: 224-534-7167
  • Fax: 888-869-5570
Mailing address:
  • Phone: 224-534-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.134524
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.134524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: