Healthcare Provider Details

I. General information

NPI: 1053583393
Provider Name (Legal Business Name): PRAIRIE STATE PULMONARY & SLEEP CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 CRAWFORD AVE STE 120
OLYMPIA FIELDS IL
60461-1173
US

IV. Provider business mailing address

20303 CRAWFORD AVE STE 120
OLYMPIA FIELDS IL
60461-1173
US

V. Phone/Fax

Practice location:
  • Phone: 708-983-6060
  • Fax: 708-747-6911
Mailing address:
  • Phone: 708-983-6060
  • Fax: 708-747-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036069751
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036069751
License Number StateIL

VIII. Authorized Official

Name: ROBERT ARONSON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 708-983-6060