Provider Demographics
NPI:1710058227
Name:CORREIA, NATALIE (DO)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CORREIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3880 SALEM LAKE DR
Mailing Address - Street 2:STE F
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5292
Mailing Address - Country:US
Mailing Address - Phone:847-235-3077
Mailing Address - Fax:847-752-6873
Practice Address - Street 1:3880 SALEM LAKE DR
Practice Address - Street 2:STE F
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5292
Practice Address - Country:US
Practice Address - Phone:847-235-3077
Practice Address - Fax:847-752-6873
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112635208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112635Medicaid
ILG73157Medicare UPIN