Provider Demographics
NPI:1508066960
Name:ALLERGY & CL IMMUNOLOGY CENTER
Entity Type:Organization
Organization Name:ALLERGY & CL IMMUNOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:TK
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-344-3550
Mailing Address - Street 1:10001 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2664
Mailing Address - Country:US
Mailing Address - Phone:708-344-3550
Mailing Address - Fax:708-344-6577
Practice Address - Street 1:1425 N MCLEAN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5723
Practice Address - Country:US
Practice Address - Phone:847-931-1999
Practice Address - Fax:847-931-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050567207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050567Medicaid
IL1617643OtherBC/BS
IL613611Medicare PIN