Healthcare Provider Details

I. General information

NPI: 1811916927
Provider Name (Legal Business Name): PULMONARY & SLEEP MEDICINE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2971 W ALGONQUIN RD STE 104
ALGONQUIN IL
60102-9407
US

IV. Provider business mailing address

2971 W ALGONQUIN RD STE 104
ALGONQUIN IL
60102-9407
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-7693
  • Fax: 847-658-7986
Mailing address:
  • Phone: 847-658-7693
  • Fax: 847-658-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDA6125
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerRAIL ROAD MEDICARE
# 2
Identifier05632031
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS/SHIELD

VIII. Authorized Official

Name: FIRAS DAIRI
Title or Position: OWNER
Credential: MD
Phone: 847-658-7693