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Individual

LATHA MARIYAPPA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4646 N MARINE DR, CHICAGO, IL 60640-5759
(773) 564-5216
(773) 564-5215
Mailing address
1535 S MONTEREY AVE, VILLA PARK, IL 60181-3434
(847) 902-9125

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036108285
IL
208M00000X
Hospitalist Physician
Primary
036108285
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036-108285
IDFPR (ILLINOIS STATE MEDICAL LICENSE)
IL
Enumeration date
08/10/2006
Last updated
03/07/2023
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