Provider Demographics
NPI:1942446760
Name:CHICAGO FAMILY ASTHMA & ALLERGY SC
Entity Type:Organization
Organization Name:CHICAGO FAMILY ASTHMA & ALLERGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEWHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-388-2322
Mailing Address - Street 1:2551 N CLARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1798
Mailing Address - Country:US
Mailing Address - Phone:773-388-2322
Mailing Address - Fax:773-388-2333
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:773-388-2322
Practice Address - Fax:773-388-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105585207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001628998OtherBCBS PROV #
ILIL1765Medicare PIN