Provider Demographics
NPI:1487658092
Name:ATKIN, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:ATKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1004 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:YATES CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66783-1314
Mailing Address - Country:US
Mailing Address - Phone:620-625-2312
Mailing Address - Fax:620-625-3560
Practice Address - Street 1:1004 E MADISON ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1314
Practice Address - Country:US
Practice Address - Phone:620-625-2312
Practice Address - Fax:620-625-3560
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-12842207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103363Medicare ID - Type Unspecified
KSB69254Medicare UPIN