Provider Demographics
NPI:1225021470
Name:NABOLOTNY, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:NABOLOTNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:STE 216
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3713
Mailing Address - Country:US
Mailing Address - Phone:773-631-0566
Mailing Address - Fax:773-631-4436
Practice Address - Street 1:7447 W TALCOTT AVE STE 216
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3713
Practice Address - Country:US
Practice Address - Phone:773-775-1900
Practice Address - Fax:773-775-8034
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36068022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01616662OtherBCBS
IL036068022Medicaid
IL110059159Medicare PIN
ILL02006Medicare PIN
IL036068022Medicaid