Healthcare Provider Details

I. General information

NPI: 1811289325
Provider Name (Legal Business Name): KANELAND ALLERGY AND ASTHMA CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 OAK ST
NORTH AURORA IL
60542-2006
US

IV. Provider business mailing address

1213 OAK ST
NORTH AURORA IL
60542-2006
US

V. Phone/Fax

Practice location:
  • Phone: 630-504-2200
  • Fax: 630-618-4799
Mailing address:
  • Phone: 630-504-2200
  • Fax: 630-618-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036-116071
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAKINA SHIKARI BAJOWALA
Title or Position: PRESIDENT
Credential: MD
Phone: 773-960-4730