Provider Demographics
NPI:1912200825
Name:MIDWEST ALLERGY INC
Entity Type:Organization
Organization Name:MIDWEST ALLERGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS-KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-1999
Mailing Address - Street 1:10001 W ROOSEVELT RD STE 304
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2662
Mailing Address - Country:US
Mailing Address - Phone:847-931-1999
Mailing Address - Fax:847-931-1721
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:2010-12-15
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050567207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13901OtherUPIN
IL036-050567Medicaid