Healthcare Provider Details

I. General information

NPI: 1386964252
Provider Name (Legal Business Name): ILLINOIS ALLERGY AND ASTHMA SPECIALISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIDGE ROAD SUITE 211A CO BUILDING
EVANSTON IL
60201-2418
US

IV. Provider business mailing address

2500 RIDGE ROAD SUITE 211A
EVANSTON IL
60201-2418
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-7909
  • Fax:
Mailing address:
  • Phone: 847-328-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIAN H CHOU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-328-7909