Provider Demographics
NPI:1619973021
Name:NACHOWICZ, ALBERT GREGORY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:GREGORY
Last Name:NACHOWICZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 E UNIVERSITY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-6204
Mailing Address - Country:US
Mailing Address - Phone:217-384-2071
Mailing Address - Fax:217-384-2095
Practice Address - Street 1:2406 E UNIVERSITY AVE
Practice Address - Street 2:STE 1
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-6204
Practice Address - Country:US
Practice Address - Phone:217-384-2071
Practice Address - Fax:217-384-2095
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4596880001OtherADMINASTAR MED B DME
IL0001032008OtherBC/BS OF ILLINOIS
IL0001032008OtherBC/BS OF ILLINOIS
201481Medicare ID - Type Unspecified