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General NPI Number Information
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NPI Number | 1942799804
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Entity Type | Individual
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Provider Name | JOHNATHON RECKNAGEL MD
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Gender | Male
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 504 E PETTIGREW ST APT 559
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City | DURHAM
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State | NC
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Zip | 27701-3896
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Country | US
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Telephone | 734-478-6731
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2022-01254
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036175917
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License Number State | IL
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