MEDICARE: MIDWEST ALLERGY & ASTHMA CLINIC LLC

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	:	1346650439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ALLERGY & ASTHMA CLINIC LLC

Provider Business Mailing Address
First Line	:	6827 KINGERY HWY
Second Line	:
City	:	WILLOWBROOK
State	:	IL
Zip	:	60527-5154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6827 KINGERY HWY
Second Line	:
City	:	WILLOWBROOK
State	:	IL
Zip	:	60527-5154
Country	:	US
Telephone Number	:	630-655-1212
Fax Number	:	630-655-6945

Authorized Official
Title or Position	:	OWNER
Name	:	NAHEED MALIK QAYYUM
Credential	:	M.D.
Telephone Number	:	630-655-1212

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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