Healthcare Provider Details

I. General information

NPI: 1134252869
Provider Name (Legal Business Name): ALLERGY AND ASTHMA ASSOCIATES OF DUPAGE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 E. OGDEN AVE. SUITE 205
NAPERVILLE IL
60563
US

IV. Provider business mailing address

3081 HANDLEY CT
LISLE IL
60532-4409
US

V. Phone/Fax

Practice location:
  • Phone: 630-852-4050
  • Fax: 630-428-9764
Mailing address:
  • Phone: 630-527-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number042003228
License Number StateIL

VIII. Authorized Official

Name: ASYA SEGALENE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-852-4050