Provider Demographics
NPI:1215197546
Name:ALLERGY & CLINICAL IMMUNOLOGY INC
Entity Type:Organization
Organization Name:ALLERGY & CLINICAL IMMUNOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:TARIQ
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-361-0730
Mailing Address - Street 1:7808 W COLLEGE DR
Mailing Address - Street 2:SUITE 1SW
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1027
Mailing Address - Country:US
Mailing Address - Phone:708-361-0730
Mailing Address - Fax:708-361-0740
Practice Address - Street 1:7808 W COLLEGE DR
Practice Address - Street 2:SUITE 1SW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1027
Practice Address - Country:US
Practice Address - Phone:708-361-0730
Practice Address - Fax:708-361-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0505567207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216213036OtherBC/BS
IL216213036OtherBC/BS