Provider Demographics
NPI:1760405666
Name:PORONSKY, ALBERT B (DO)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:B
Last Name:PORONSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:21202 OWENS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2001
Mailing Address - Country:US
Mailing Address - Phone:779-334-0020
Mailing Address - Fax:779-334-0021
Practice Address - Street 1:21202 OWENS RD STE 201
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2001
Practice Address - Country:US
Practice Address - Phone:779-334-0020
Practice Address - Fax:779-334-0021
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC49037Medicare UPIN