=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407011703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBERTO LOCANTE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2008
-----------------------------------------------------
Last Update Date | 01/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7435 W TALCOTT AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60631-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-527-5860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 E 22ND ST
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-6110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-960-9222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZB0001X
-----------------------------------------------------
Taxonomy Name | Blood Banking & Transfusion Medicine Physician
-----------------------------------------------------
License Number | 036121048
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 036121048
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------