Healthcare Provider Details

I. General information

NPI: 1811976475
Provider Name (Legal Business Name): IRMA M OLIFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SKOKIE BLVD STE 140
NORTHBROOK IL
60062-2856
US

IV. Provider business mailing address

500 SKOKIE BLVD STE 140
NORTHBROOK IL
60062-2856
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-4296
  • Fax:
Mailing address:
  • Phone: 847-272-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036-099000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: