Provider Demographics
NPI:1194461772
Name:ALUTTO, JULIAN AILIS
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:AILIS
Last Name:ALUTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 W JACKSON BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3227
Mailing Address - Country:US
Mailing Address - Phone:312-942-8028
Mailing Address - Fax:
Practice Address - Street 1:1645 W JACKSON BLVD STE 215
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3227
Practice Address - Country:US
Practice Address - Phone:312-942-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.083241207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine