Organization
ATKINSON CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGEI SHEVLYAGIN MD (OWNER)
(847) 548-9777
Entity
Organization
Contact information
Practice address
100 N ATKINSON RD STE 207, GRAYSLAKE, IL 60030-7804
(847) 548-9777
(847) 548-9797
Mailing address
100 N ATKINSON RD STE 207, GRAYSLAKE, IL 60030-7804
(847) 548-9777
(847) 548-9797
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036978646
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036978646
—
IL
01
—
110224169
RAIL ROAD MEDICARE
IL
01
—
4927894
BLUE CROSS/SHIELD
IL
Enumeration date
08/09/2006
Last updated
08/21/2012
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