JORDAN B PRITIKIN (NPI# 1770585259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770585259 |
| Entity Type | Individual |
| Full Name | JORDAN B PRITIKIN |
| Credential | M.D. |
| Practice Address |
111 W Washington St Suite 903 Chicago IL 60602-2703 |
| Mailing Address |
Po Box 160 Matteson IL 60443-0160 |
| Practice Telephone | 3123729355 |
| Practice Fax Number | 3123729356 |
| Mailing Telephone | 7087475850 |
| Mailing Fax Number | 7087479991 |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2009-11-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
036087346 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036087346 | 05 | |
| IL | RRMC | 040017908 | 01 |
| Street Address |
111 W WASHINGTON ST SUITE 903 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60602-2703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831549427 | Lauren Domski | Nurse Practitioner | 111 W Washington St, Suite 901, Chicago, IL 60602-2703 | 2016-06-15 |
| 1083069199 | Dental Loft - The Loop | Dentist | 111 W Washington St, Suite 1350, Chicago, IL 60602-2703 | 2016-04-26 |
| 1538595434 | Ageless Men's Health Holdings, LLC | Specialist | 111 W Washington St, Suite 901, Chicago, IL 60602-2703 | 2013-09-24 |
| 1033340153 | Amy Brussee | Physician Assistant | 111 W Washington St, Suite 903, Chicago, IL 60602-2703 | 2009-08-06 |
| 1609899913 | Kevin E. Hunt | Internal Medicine | 111 W Washington St, Suite 1801, Chicago, IL 60602-2703 | 2006-07-26 |
| 1578592069 | Brian P. Lavery | Internal Medicine | 111 W Washington St, Suite 1801, Chicago, IL 60602-2703 | 2006-06-30 |
| 1104852722 | Anne M. Suh | Internal Medicine | 111 W Washington St, Suite 1801, Chicago, IL 60602-2703 | 2006-06-24 |
| 1578509451 | Audrey M. Tatar | Internal Medicine | 111 W Washington St, Suite 1801, Chicago, IL 60602-2703 | 2006-06-21 |
| 1154367167 | Arnold M. Tatar | Internal Medicine | 111 W Washington St, Suite 1801, Chicago, IL 60602-2703 | 2006-06-20 |
| 1710932728 | Arnold M. Tatar, Md Sc | Internal Medicine | 111 W Washington St, Suite 1801, Chicago, IL 60602-2703 | 2006-05-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710539705 | Biyang Wang | Social Worker | 9 W Washington St, Chicago, IL 60602 | 2019-07-10 |
| 1538724349 | Megan Asta Sarasek | Social Worker | 134 N Lasalle Street, Suite 400, Chicago, IL 60602 | 2019-05-07 |
| 1659850691 | Sara Chen | Dentist | 105 West Madison, 3rd Floor, Chicago, IL 60602 | 2018-08-10 |
| 1942795059 | Pratiti Rajeshkumar Gandhi | Dentist | 33 N Dearborn St Ste 2400, Chicago, IL 60602 | 2018-06-30 |
| 1154833994 | Ywca Metropolitan Chicago | Counselor | 1 North Lasalle Street, Suite 1150, Chicago, IL 60602 | 2017-11-02 |
| 1013434620 | Michelle Malters | Counselor | 30 N Michigan Ave Ste 1909, Chicago, IL 60602 | 2017-08-24 |
| 1740729474 | Jd Manikowski, D.d.s., LLC | Health Maintenance Organization | 30 N. Michigan Ave #1520, Chicago, IL 60602 | 2017-02-14 |
| 1568909943 | Pratiksha Agrawal | Dentist | 105 W Madison St Fl 3, Chicago, IL 60602 | 2017-01-24 |
| 1790221521 | Anastasia Scangas | Social Worker | 30 N Michigan Ave Ste 826, Chicago, IL 60602 | 2017-01-18 |
| 1194269837 | Jenna Peterson | Psychologist | 111 N Wabash Ave Ste 822, Chicago, IL 60602 | 2016-12-15 |
| Find all providers in zip 60602 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558646745 | Peter Anthony Brusca | Otolaryngology | 1310 N Ritchie Ct, 29b, Chicago, IL 60610-2168 | 2011-10-19 |
| 1982609103 | Gordon J Siegel | Otolaryngology | 3 E Huron St, Fl 1, Chicago, IL 60611-2887 | 2005-06-15 |
| 1962880419 | Richard Kao | Otolaryngology | 1611 W Harrison St, Chicago, IL 60612-4861 | 2015-05-15 |
| 1780674515 | Associates In Head & Neck Surgery | Otolaryngology | 1725 W Harrison St, Suite 938, Chicago, IL 60612-3841 | 2005-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942310081 | Parkview Ear, Nose & Throat Clinic, S.c. | Otolaryngology | 112 Park Ridge Ln, Pekin, IL 61554-3900 | 2006-08-30 |
| 1295707578 | James Curtis Hertenstein | Otolaryngology | 8600 N State Rt 91, Ste 300, Peoria, IL 61615 | 2006-02-02 |
| 1720068695 | Fazlur R. Zahurullah | Otolaryngology | 3401 N Perryville Rd, Rockford, IL 61114-8011 | 2006-01-18 |
| 1467816918 | Smart Sinus and Allergy Florida LLC | Otolaryngology | 1100 E Woodfield Rd, Suite 140, Schaumburg, IL 60173-5116 | 2016-04-11 |
| 1194163139 | Finn R. Amble, M.d. F.a.c.s., S.c | Otolaryngology | 1505 Eastland Dr, Suite 220, Bloomington, IL 61701-3534 | 2013-06-12 |
| 1861731689 | Hosseinali Jafari | Otolaryngology | 301 N 8th St, Springfield, IL 62701-1041 | 2013-02-14 |
| 1467601583 | Muthuswamy Dhiwakar | Otolaryngology | 301 N 8th St, Springfield, IL 62701-1041 | 2008-09-12 |
| 1508065558 | James J Klemens | Otolaryngology | 7301 N Knoxville Ave, Peoria, IL 61614-2017 | 2007-07-11 |
| 1417096090 | Nathan David Joos | Otolaryngology | 1025 S 6th St, Springfield, IL 62703-2403 | 2007-02-06 |
| 1598722712 | Steven M Sobol | Otolaryngology | 101 W Mckinley Ave, Enta Allergy, Head & Neck Institute, Decatur, IL 62526 | 2006-05-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.