MEDICARE: LATA JAIN AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	147001053	IL

General Provider Information

NPI Number	:	1487693511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATA JAIN AUD

Provider Business Mailing Address
First Line	:	2665 N HARTLAND CT
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4960
Country	:	US
Telephone Number	:	847-452-9659
Fax Number	:	773-303-8297

Provider Business Practice Location Address
First Line	:	8 S MICHIGAN AVE STE 2212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-3335
Country	:	US
Telephone Number	:	312-346-1136
Fax Number	:	312-853-2293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	01/07/2020

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