Provider Demographics
NPI:1770580029
Name:ATIA, GEORGE N (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:N
Last Name:ATIA
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 1:200 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1809
Mailing Address - Country:US
Mailing Address - Phone:847-382-7165
Mailing Address - Fax:847-713-8160
Practice Address - Street 1:200 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1809
Practice Address - Country:US
Practice Address - Phone:847-382-7165
Practice Address - Fax:847-713-8160
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2021-12-18
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IL036096799207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202028OtherPTAN
IL214879OtherPTAN
IL01632295OtherBCBS OF IL
IL036096799Medicaid
IL100016570OtherPALMETO RAILROAD MEDICARE
IL202028OtherPTAN