Provider Demographics
NPI:1275989378
Name:NATKOW, NEIL (DO)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:NATKOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 EAGLE RUN WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1432
Mailing Address - Country:US
Mailing Address - Phone:954-646-6761
Mailing Address - Fax:954-389-2681
Practice Address - Street 1:2447 EAGLE RUN WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1432
Practice Address - Country:US
Practice Address - Phone:954-646-6761
Practice Address - Fax:954-389-2681
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4423207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0467821Medicaid
FL80014OtherMEDICARE PARTICIPATING OR SUPPLIER AGREEMENT