Healthcare Provider Details

I. General information

NPI: 1235130246
Provider Name (Legal Business Name): JOHN W. LAUDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BERTEAU AVE
ELMHURST IL
60126-2966
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-1400
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number036059139
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: