Healthcare Provider Details

I. General information

NPI: 1447889746
Provider Name (Legal Business Name): WILSON FELIX PALADO LAO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

11234 ANDERSON ST GME OFFICE WESTERLY SUITE 'C'
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA191574
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036175458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: