Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 00000000000000000 | IL |
NPI | 1033372750 |
---|---|
Provider Name | Dr. Alphi P Elackattu |
First Address | Chicago, IL 60631-3707 |
Second Address | Evanston, IL 60202-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 15/03/2021 |