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General NPI Number Information
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NPI Number | 1720048572
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Entity Type | Individual
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Provider Name | JOSHUA BENJAMIN NATHAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 581 ELM PL STE 110
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3122
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Country | US
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Telephone | 888-428-7890
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Fax | 630-428-7891
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Provider Business Mailing Address
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Address Line | 1 E ERIE ST STE 525
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City | CHICAGO
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State | IL
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Zip | 60611-2980
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Country | US
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Telephone | 312-820-9127
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Fax | 415-397-3629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C171521
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CDR.0001023
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.124276
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License Number State | IL
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