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Individual
JOHN G LATALL
Active
Individual
JOHN G LATALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
036-084430
IL
207K00000X
Allergy & Immunology Physician
036084430
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621679
BCBS OF IL
IL
05
—
036084430 / 02
—
IL
Enumeration date
12/21/2005
Last updated
12/14/2021
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