Provider Demographics
NPI:1134485055
Name:JOHN G LATALL MD SC
Entity Type:Organization
Organization Name:JOHN G LATALL MD SC
Other - Org Name:PREMIER ALLERGY, ASTHMA AND SINUS SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LATALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-665-4016
Mailing Address - Street 1:2073 N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4003
Mailing Address - Country:US
Mailing Address - Phone:773-665-4016
Mailing Address - Fax:773-665-0403
Practice Address - Street 1:2073 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4003
Practice Address - Country:US
Practice Address - Phone:773-665-4016
Practice Address - Fax:773-360-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207KA0200X
IL036-084430261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty