Provider Demographics
NPI:1962862334
Name:SAINT JUDE OFFICES, LLC
Entity Type:Organization
Organization Name:SAINT JUDE OFFICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SYLVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-527-7410
Mailing Address - Street 1:328 N MICHIGAN ST
Mailing Address - Street 2:SUITE F3
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1244
Mailing Address - Country:US
Mailing Address - Phone:262-527-7410
Mailing Address - Fax:
Practice Address - Street 1:328 N MICHIGAN ST
Practice Address - Street 2:SUITE F3
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1244
Practice Address - Country:US
Practice Address - Phone:262-527-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty