Healthcare Provider Details

I. General information

NPI: 1508066960
Provider Name (Legal Business Name): ALLERGY & CL IMMUNOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N MCLEAN BLVD SUITE 100
ELGIN IL
60123-5723
US

IV. Provider business mailing address

10001 W ROOSEVELT RD SUITE 304
WESTCHESTER IL
60154-2664
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-1999
  • Fax: 847-931-1721
Mailing address:
  • Phone: 708-344-3550
  • Fax: 708-344-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036050567
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMAD TK GHANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-344-3550