Provider Demographics
NPI:1700987708
Name:NATHAN, R DEVA (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:DEVA
Last Name:NATHAN
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 1:3800 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2718
Mailing Address - Country:US
Mailing Address - Phone:773-205-8415
Mailing Address - Fax:773-205-8436
Practice Address - Street 1:3800 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2718
Practice Address - Country:US
Practice Address - Phone:773-205-8415
Practice Address - Fax:773-205-8436
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 043661207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043661Medicaid
IL539760Medicare ID - Type Unspecified
C41403Medicare UPIN