Provider Demographics
NPI:1578656484
Name:SOUTHWEST ALLERGY ASSOCIATES.S.C.
Entity Type:Organization
Organization Name:SOUTHWEST ALLERGY ASSOCIATES.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-4848
Mailing Address - Street 1:5423 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3789
Mailing Address - Country:US
Mailing Address - Phone:708-422-4848
Mailing Address - Fax:708-422-7342
Practice Address - Street 1:5423 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3789
Practice Address - Country:US
Practice Address - Phone:708-422-4848
Practice Address - Fax:708-422-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21603560OtherBCBS
IL652190Medicare PIN
IL21603560OtherBCBS