Provider Demographics
NPI:1073608162
Name:WEST SUBURBAN INFECTIOUS DISEASE SPECIALISTS SC
Entity Type:Organization
Organization Name:WEST SUBURBAN INFECTIOUS DISEASE SPECIALISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAUSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALFONSO LAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-763-8381
Mailing Address - Street 1:610 S MAPLE AVE
Mailing Address - Street 2:SUITE 5700
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304
Mailing Address - Country:US
Mailing Address - Phone:708-763-8381
Mailing Address - Fax:708-763-8390
Practice Address - Street 1:610 S MAPLE AVE
Practice Address - Street 2:SUITE 5700
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304
Practice Address - Country:US
Practice Address - Phone:708-763-8381
Practice Address - Fax:708-763-8390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617977207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01632409OtherBCBS
01632409OtherBCBS