Healthcare Provider Details

I. General information

NPI: 1265644355
Provider Name (Legal Business Name): ADVANCED ALLERGY & ASTHMA CARE S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE SUITE 204, EAST BUILDING
ORLAND PARK IL
60462-4600
US

IV. Provider business mailing address

15300 WEST AVENUE SUITE 204, EAST BUILDING
ORLAND PARK IL
60462
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-7355
  • Fax:
Mailing address:
  • Phone: 708-460-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036112759
License Number StateIL

VIII. Authorized Official

Name: DR. AMEE MAJMUNDAR
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 708-460-7355