Provider Demographics
NPI:1205875119
Name:NAPERVILLE EAR, NOSE AND THROAT ASSOCIATES., LTD.
Entity type:Organization
Organization Name:NAPERVILLE EAR, NOSE AND THROAT ASSOCIATES., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-355-5668
Mailing Address - Street 1:10 W MARTIN AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6535
Mailing Address - Country:US
Mailing Address - Phone:630-355-5668
Mailing Address - Fax:630-355-2071
Practice Address - Street 1:10 W MARTIN AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6535
Practice Address - Country:US
Practice Address - Phone:630-355-5668
Practice Address - Fax:630-355-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074435207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03609740311Medicaid
IL03609740311Medicaid