Provider Demographics
NPI:1679512263
Name:NAGPAL, LATA J (MD)
Entity Type:Individual
Prefix:
First Name:LATA
Middle Name:J
Last Name:NAGPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W 87TH STREET
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-961-2011
Mailing Address - Fax:630-961-2067
Practice Address - Street 1:519 W 87TH STREET
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:630-961-2011
Practice Address - Fax:630-961-2067
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068398Medicaid
K21592Medicare UPIN
IL036068398Medicaid