Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 036.152970 | IL |
NPI | 1699188623 |
---|---|
Provider Name | John Palla |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 16/07/2020 |