Provider Demographics
NPI:1053388520
Name:LAGATTUTA, JOSEPH ANTHONY JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:LAGATTUTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E NORTH AVE
Mailing Address - Street 2:DEPT OF GI
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-458-5300
Mailing Address - Fax:630-307-2751
Practice Address - Street 1:630 E NORTH AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2127
Practice Address - Country:US
Practice Address - Phone:630-458-5300
Practice Address - Fax:630-307-2751
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065102207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E15116Medicare UPIN
IL036065102Medicaid
IL972730Medicare ID - Type Unspecified