Basic Information
| Provider Information | |||||||||
| NPI: | 1184116386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAUTLET | ||||||||
| FirstName: | ARNAUD | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2024 W IOWA ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606225378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126183146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126958624 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125.072233 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 207K00000X | 036159272 | IL | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207R00000X | 125.072233 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.