Provider Demographics
NPI:1376543702
Name:CHATTO, ELADIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELADIO
Middle Name:M
Last Name:CHATTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:ROSICLARE
Mailing Address - State:IL
Mailing Address - Zip Code:62982-2467
Mailing Address - Country:US
Mailing Address - Phone:618-285-6634
Mailing Address - Fax:618-285-3564
Practice Address - Street 1:6 FERRELL RD.
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-6634
Practice Address - Fax:619-285-3564
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43012Medicaid
ILC43012Medicaid
ILP14723Medicare ID - Type Unspecified