Provider Demographics
NPI:1790125953
Name:CHICAGO SINUS & ALLERGY CENTER
Entity Type:Organization
Organization Name:CHICAGO SINUS & ALLERGY CENTER
Other - Org Name:MI FACE AND BODY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAATSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-724-6673
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 903
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-724-6673
Mailing Address - Fax:877-816-0973
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 903
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-724-6673
Practice Address - Fax:877-816-0973
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO SINUS & ALLERGY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-02
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127928207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty