Provider Demographics
NPI:1649310384
Name:TALOSIG, IGNACIO CHAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:CHAN
Last Name:TALOSIG
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:13656 LAMON AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60445-1833
Mailing Address - Country:US
Mailing Address - Phone:708-371-3546
Mailing Address - Fax:
Practice Address - Street 1:19600 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9321
Practice Address - Country:US
Practice Address - Phone:708-478-3000
Practice Address - Fax:708-478-3007
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-014184OtherSTATE LICENSE
K36054Medicare UPIN