Provider Demographics
NPI:1407866270
Name:LAFATA, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:LAFATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-0500
Mailing Address - Country:US
Mailing Address - Phone:217-670-2424
Mailing Address - Fax:217-670-2809
Practice Address - Street 1:2901 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-698-9722
Practice Address - Fax:217-391-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCD7143OtherRR MEDICARE GROUP
IL036064343OtherIL STATE LICENSE
IL036064343Medicaid
IL091117OtherHEALTH ALLIANCE
IL100843OtherHEALTHLINK
IL14D0949277OtherCLIA
IL020057300OtherBLACK LUNG
ILP00144455OtherRR MEDICARE PIN
IL08421024OtherBC/BS
IL6394POtherCATERPILLAR
IL133586700OtherACS-OWCP
IL091117OtherHEALTH ALLIANCE