Provider Demographics
NPI:1184829210
Name:ALLERGY, ASTHMA & IMMUNOLOGY CENTER SC
Entity Type:Organization
Organization Name:ALLERGY, ASTHMA & IMMUNOLOGY CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-624-2060
Mailing Address - Street 1:325 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2993
Mailing Address - Country:US
Mailing Address - Phone:618-624-2060
Mailing Address - Fax:618-624-2226
Practice Address - Street 1:325 TAMARACK LN
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2993
Practice Address - Country:US
Practice Address - Phone:618-624-2060
Practice Address - Fax:618-624-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty