1457562944 NPI number — DR. JAMES C GARITI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457562944 NPI number — DR. JAMES C GARITI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GARITI

Provider First Name:

JAMES

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1457562944

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/13/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2001 BUTTERFIELD RD

Provider Second Line Business Mailing Address:

SUITE 300

Provider Business Mailing Address City Name:

DOWNERS GROVE

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60515-1050

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

630-725-2832

Provider Business Mailing Address Fax Number:

877-489-5993

Provider First Line Business Practice Location Address:

245 S EXECUTIVE DR

Provider Second Line Business Practice Location Address:

SUITE 350

Provider Business Practice Location Address City Name:

BROOKFIELD

Provider Business Practice Location Address State Name:

WI

Provider Business Practice Location Address Postal Code:

53005-4204

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

262-373-1647

Provider Business Practice Location Address Fax Number:

262-373-1650

Provider Enumeration Date:

05/25/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208D00000X , with the licence number:  46635020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2083X0100X , with the licence number: 46635-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 202K00000X , with the licence number: 46635-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 036121623 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 789510 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 000068227 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
• Identifier: P01658759 . This is a "MECICARE RAILROAD INDIVIDUAL PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
• Identifier: 789511 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: DE2420 . This is a "MEDICARE RAILROAD GROUP PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".