Provider Demographics
NPI:1467669374
Name:ADVANCED ALLERGY & ASTHMA CLINIC S C
Entity Type:Organization
Organization Name:ADVANCED ALLERGY & ASTHMA CLINIC S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-378-4014
Mailing Address - Street 1:402 W BOUGHTON RD
Mailing Address - Street 2:SUITE F-1
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1872
Mailing Address - Country:US
Mailing Address - Phone:630-378-4014
Mailing Address - Fax:630-378-4784
Practice Address - Street 1:402 W BOUGHTON RD
Practice Address - Street 2:SUITE F-1
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1872
Practice Address - Country:US
Practice Address - Phone:630-378-4014
Practice Address - Fax:630-378-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077398Medicaid
IL036077398Medicaid
IL699860Medicare ID - Type Unspecified