Provider Demographics
NPI:1518975309
Name:KAKISH, NATHAN M (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:M
Last Name:KAKISH
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 1:1925 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-9301
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-428-7425
Practice Address - Street 1:1925 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-9301
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-428-7425
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116194208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518975309OtherBCBSWI
IL036116194 1Medicaid
WIKAKISNATOtherMERCYCARE INSURANCE
WI1518975309Medicaid
IL036116194 1Medicaid