Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 036-065457 | IL |
NPI | 1609862267 |
---|---|
Provider Name | John Maddalozzo |
First Address | Chicago, IL 60611-2605 |
Second Address | Chicago, IL 60611-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 17/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036065457 | (05) | IL |
1627123 | BCBS PROVIDER ID (01) | IL |
2386216 | (05) | OH |
C41714 | (02) | IL |