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NPI Code Detail

MEDICARE: DR. STEFAN ELLIOT LATULIP PH.D.

MEDICARE: DR. STEFAN ELLIOT LATULIP PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist071010810IL

General Provider Information

NPI Number : 1760101125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEFAN ELLIOT LATULIP PH.D.
Provider Business Mailing Address
First Line : 2021 MIDWEST RD STE 104
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1396
Country : US
Telephone Number : 630-280-8173
Fax Number :
Provider Business Practice Location Address
First Line : 2021 MIDWEST RD STE 104
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1396
Country : US
Telephone Number : 630-280-8173
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2022
Last Update Date : 08/26/2022

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