Provider Demographics
NPI:1356642912
Name:MIDWEST ALLERGY & ASTHMA INC
Entity Type:Organization
Organization Name:MIDWEST ALLERGY & ASTHMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-344-3550
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:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050567207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13901OtherUPIN
IL036-050567Medicaid