Provider Demographics
NPI:1922021005
Name:PAUL T ATKENSON, MDSC
Entity Type:Organization
Organization Name:PAUL T ATKENSON, MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ATKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-460-4422
Mailing Address - Street 1:14640 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2698
Mailing Address - Country:US
Mailing Address - Phone:708-460-4422
Mailing Address - Fax:708-460-9254
Practice Address - Street 1:14640 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2698
Practice Address - Country:US
Practice Address - Phone:708-460-4422
Practice Address - Fax:708-460-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL905280Medicare ID - Type Unspecified