Provider Demographics
NPI:1922269190
Name:ATALLAH, CARL K (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:K
Last Name:ATALLAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0463
Mailing Address - Country:US
Mailing Address - Phone:773-281-5818
Mailing Address - Fax:773-281-6859
Practice Address - Street 1:3000 N HALSTED ST STE 625
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5196
Practice Address - Country:US
Practice Address - Phone:773-281-5818
Practice Address - Fax:773-281-6859
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036127620207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400145031OtherPTAN