MEDICARE: ADVANCED ALLERGY & ASTHMA ASSOCIATES 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1629122403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ALLERGY & ASTHMA ASSOCIATES SC

Provider Business Mailing Address
First Line	:	730 E TERRA COTTA AVE
Second Line	:	SUITE A
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3615
Country	:	US
Telephone Number	:	847-888-8802
Fax Number	:	866-246-1164

Provider Business Practice Location Address
First Line	:	730 E TERRA COTTA AVE
Second Line	:	SUITE A
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3615
Country	:	US
Telephone Number	:	847-888-8802
Fax Number	:	866-246-1164

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NOGA ASKENAZI
Credential	:	MD
Telephone Number	:	847-888-8802

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/17/2017

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