Provider Demographics
NPI:1053503383
Name:DUKANE ALLERGY ASSOCIATES. LTD
Entity Type:Organization
Organization Name:DUKANE ALLERGY ASSOCIATES. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-584-6127
Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-584-6127
Mailing Address - Fax:630-584-6070
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-584-6127
Practice Address - Fax:630-584-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL50783138305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4515125OtherBLUE CROSS/BLUE SHIELD
IL4515125OtherBLUE CROSS/BLUE SHIELD