MEDICARE: WESTERN SPRINGS ASTHMA & ALLERGY SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1235111824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN SPRINGS ASTHMA & ALLERGY SC

Provider Business Mailing Address
First Line	:	5600 WOLF RD
Second Line	:	SUITE 135
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-4515
Fax Number	:	708-246-4502

Provider Business Practice Location Address
First Line	:	5600 WOLF RD
Second Line	:	SUITE 135
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-4515
Fax Number	:	708-246-4502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RENEE LANTNER
Credential	:	MD
Telephone Number	:	708-246-4515

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	12/09/2014

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