Healthcare Provider Details

I. General information

NPI: 1275588824
Provider Name (Legal Business Name): ALLERGY EAR NOSE THROAT,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 WARREN AVE
DOWNERS GROVE IL
60515-3601
US

IV. Provider business mailing address

2320 DEAN ST STE 103
ST CHARLES IL
60175-1068
US

V. Phone/Fax

Practice location:
  • Phone: 630-969-9200
  • Fax:
Mailing address:
  • Phone: 630-377-0106
  • Fax: 630-377-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELO ROBERT CONSIGLIO
Title or Position: OWNER
Credential: MD
Phone: 630-675-6700