Healthcare Provider Details

I. General information

NPI: 1790125953
Provider Name (Legal Business Name): CHICAGO SINUS & ALLERGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE SUITE 903
CHICAGO IL
60611-2615
US

IV. Provider business mailing address

737 N MICHIGAN AVE SUITE 903
CHICAGO IL
60611-2615
US

V. Phone/Fax

Practice location:
  • Phone: 312-724-6673
  • Fax: 877-816-0973
Mailing address:
  • Phone: 312-724-6673
  • Fax: 877-816-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number036127928
License Number StateIL

VIII. Authorized Official

Name: LAUREN LAATSCH
Title or Position: OFFICE MANAGER
Credential:
Phone: 312-724-6673