Provider Demographics
NPI:1932380078
Name:ALLERGY AND ASTHMA ASSOCIATES OF JOLIET, S.C.
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA ASSOCIATES OF JOLIET, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:VORAPHOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SATHISSARAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-1212
Mailing Address - Street 1:2000 GLENWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5676
Mailing Address - Country:US
Mailing Address - Phone:815-741-1212
Mailing Address - Fax:815-741-0707
Practice Address - Street 1:2000 GLENWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5676
Practice Address - Country:US
Practice Address - Phone:815-741-1212
Practice Address - Fax:815-741-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046328261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932417OtherBCBS
IL036046328Medicaid
ILC45403Medicare UPIN
IL09932417OtherBCBS