Provider Demographics
NPI:1972559615
Name:NATHANSON, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:950 TECHNOLOGY WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5366
Mailing Address - Country:US
Mailing Address - Phone:224-407-4400
Mailing Address - Fax:224-407-2255
Practice Address - Street 1:40 SKOKIE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1614
Practice Address - Country:US
Practice Address - Phone:224-407-4400
Practice Address - Fax:224-407-2255
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-09-26
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Provider Licenses
StateLicense IDTaxonomies
IL036105275207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH78225Medicare UPIN