Basic Information
| Provider Information | |||||||||
| NPI: | 1255587770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAACA | ||||||||
| FirstName: | ALLAN | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7818 DEL CT | ||||||||
| Address2: | |||||||||
| City: | DARIEN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605614550 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 W POLK ST., ADMIN BUILDING 10TH FLOOR | ||||||||
| Address2: | JOHN. H. STROGER JR. HOSPITAL OF COOK COUNTY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128640065 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125053965 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.