Provider Demographics
NPI:1093860892
Name:ATKINSON, JANIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRISTATE INTERNATIONAL STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-4419
Mailing Address - Country:US
Mailing Address - Phone:847-205-4700
Mailing Address - Fax:847-205-4477
Practice Address - Street 1:355 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3328
Practice Address - Country:US
Practice Address - Phone:847-316-2284
Practice Address - Fax:847-316-2943
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076150207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618679OtherBLUE SHIELD
IL01618679OtherBLUE SHIELD
ILL20677Medicare ID - Type Unspecified