Provider Demographics
NPI:1811289325
Name:KANELAND ALLERGY AND ASTHMA CENTER SC
Entity type:Organization
Organization Name:KANELAND ALLERGY AND ASTHMA CENTER SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAKINA
Authorized Official - Middle Name:SHIKARI
Authorized Official - Last Name:BAJOWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-960-4730
Mailing Address - Street 1:1213 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2006
Mailing Address - Country:US
Mailing Address - Phone:630-504-2200
Mailing Address - Fax:630-618-4799
Practice Address - Street 1:1213 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-2006
Practice Address - Country:US
Practice Address - Phone:630-504-2200
Practice Address - Fax:630-618-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
IL036-116071207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty