Provider Demographics
NPI:1265644355
Name:ADVANCED ALLERGY & ASTHMA CARE S.C.
Entity Type:Organization
Organization Name:ADVANCED ALLERGY & ASTHMA CARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJMUNDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-460-7355
Mailing Address - Street 1:15300 WEST AVENUE
Mailing Address - Street 2:SUITE 204, EAST BUILDING
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-460-7355
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 204, EAST BUILDING
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-460-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112759207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7254711OtherAETNA
IL01635439OtherBLUE CROSS PPO
IL01635439OtherBLUE CROSS PPO
IL7254711OtherAETNA