Provider Demographics
NPI:1407879547
Name:ATKENSON, PAUL T (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:ATKENSON
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 1:14640 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2698
Mailing Address - Country:US
Mailing Address - Phone:708-460-4422
Mailing Address - Fax:708-460-9254
Practice Address - Street 1:14640 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2698
Practice Address - Country:US
Practice Address - Phone:708-460-4422
Practice Address - Fax:708-460-9254
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL905280Medicare ID - Type Unspecified
ILE19006Medicare UPIN