Healthcare Provider Details

I. General information

NPI: 1518960145
Provider Name (Legal Business Name): PAUL J TOUSSAINT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 467
CHICAGO IL
60631-3715
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 467
CHICAGO IL
60631-3715
US

V. Phone/Fax

Practice location:
  • Phone: 773-763-1126
  • Fax:
Mailing address:
  • Phone: 773-763-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: