Provider Demographics
NPI:1457677122
Name:ILLINOIS ALLERGY ASTHMA & SINUS CENTER INC
Entity Type:Organization
Organization Name:ILLINOIS ALLERGY ASTHMA & SINUS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROTSKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-877-3500
Mailing Address - Street 1:4801 W PETERSON AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-877-3500
Mailing Address - Fax:888-228-2622
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-877-3500
Practice Address - Fax:888-228-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102370207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH36114Medicare UPIN