Provider Demographics
NPI:1760590889
Name:WATSON, ARTELIO L (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTELIO
Middle Name:L
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:836 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:318
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3667
Mailing Address - Country:US
Mailing Address - Phone:847-303-0701
Mailing Address - Fax:847-303-0709
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:166A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-7530
Practice Address - Fax:773-947-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2012-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036112663208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112663Medicaid
I48363Medicare UPIN
IL036112663Medicaid