Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 036059139 | IL |
NPI | 1235130246 |
---|---|
Provider Name | John W. Laude |
First Address | Lombard, IL 60148-6110 |
Second Address | Elmhurst, IL 60126-2966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 20/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D14926 | (02) | IL |