Healthcare Provider Details

I. General information

NPI: 1528015179
Provider Name (Legal Business Name): MAHER DALATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 03/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 CERMAK RD STE A
BERWYN IL
60402-2173
US

IV. Provider business mailing address

6917 CERMAK RD STE A
BERWYN IL
60402-2173
US

V. Phone/Fax

Practice location:
  • Phone: 708-749-7002
  • Fax:
Mailing address:
  • Phone: 708-749-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036087750
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036087750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: