Provider Demographics
NPI:1750514378
Name:TATIYANA URBIN, D.C. LTD
Entity type:Organization
Organization Name:TATIYANA URBIN, D.C. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIYANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:URBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-659-1658
Mailing Address - Street 1:9801 GROSS POINT RD
Mailing Address - Street 2:STE.203
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1173
Mailing Address - Country:US
Mailing Address - Phone:224-659-1658
Mailing Address - Fax:847-677-4717
Practice Address - Street 1:222 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5159
Practice Address - Country:US
Practice Address - Phone:847-657-1600
Practice Address - Fax:847-657-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009006261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01625853OtherBLUE CROSS BLUE SHIELD
IL038009006Medicaid
ILU79401Medicare UPIN
IL575150Medicare PIN