Provider Demographics
NPI:1639454119
Name:CHICAGOLAND ALLERGY AND ASTHMA CONSULTANTS LTD
Entity Type:Organization
Organization Name:CHICAGOLAND ALLERGY AND ASTHMA CONSULTANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRMALA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-687-3855
Mailing Address - Street 1:6320 159TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2776
Mailing Address - Country:US
Mailing Address - Phone:708-687-3855
Mailing Address - Fax:708-444-2324
Practice Address - Street 1:6320 159TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2776
Practice Address - Country:US
Practice Address - Phone:708-687-3855
Practice Address - Fax:708-444-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6426Medicare PIN