JOHN G LATALL MD

Allergy and Immunology

Chicago, Illinois

Provider NPI: 1487630364

Provider Information:
 JOHN G LATALL MD


Practice Location:
2073 N CLYBOURN AVE  CHICAGO, IL 60614 US
Tel: 773-665-4016  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	207K00000X	Physicians Allergy & Immunology	IL	036084430
Y	207K00000X	Physicians Allergy & Immunology	IL	036-084430

Other Provider Identifiers:

Issuer	Number	State	Type
	036084430 / 02	IL	05
BCBS OF IL	01621679	IL	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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