Provider Demographics
NPI:1255341970
Name:ORKIN, BRUCE ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ANDREW
Last Name:ORKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2501
Mailing Address - Country:US
Mailing Address - Phone:217-383-3080
Mailing Address - Fax:217-383-4868
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2501
Practice Address - Country:US
Practice Address - Phone:217-383-3080
Practice Address - Fax:217-383-4868
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0050656208C00000X
DC17999208C00000X
FLME134093208C00000X
IL036132041208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC028374600Medicaid
DC000W22M83Medicare ID - Type Unspecified
DC028374600Medicaid