Provider Demographics
NPI:1003959933
Name:ALLAN J OLTHOFF DO SC
Entity Type:Organization
Organization Name:ALLAN J OLTHOFF DO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-623-3007
Mailing Address - Street 1:4524 S OAKENWALD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4514
Mailing Address - Country:US
Mailing Address - Phone:312-623-3007
Mailing Address - Fax:847-282-3862
Practice Address - Street 1:400 LAKE COOK RD
Practice Address - Street 2:200C
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5607
Practice Address - Country:US
Practice Address - Phone:847-267-0260
Practice Address - Fax:847-282-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064582261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service