Provider Demographics
NPI:1578662417
Name:ALLERGY & ASTHMA PHYSICIANS, S. C
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA PHYSICIANS, S. C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-455-0456
Mailing Address - Street 1:911 N ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3642
Mailing Address - Country:US
Mailing Address - Phone:630-455-0456
Mailing Address - Fax:
Practice Address - Street 1:911 N ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3642
Practice Address - Country:US
Practice Address - Phone:630-455-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL560280Medicare ID - Type Unspecified