Healthcare Provider Details

I. General information

NPI: 1396894812
Provider Name (Legal Business Name): ALLERGY & ASTHMA MEDICAL ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 DEAN ST STE M
ST CHARLES IL
60175-1059
US

IV. Provider business mailing address

389 S SCHMALE RD
CAROL STREAM IL
60188-2756
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-9610
  • Fax: 630-668-9813
Mailing address:
  • Phone: 630-668-9610
  • Fax: 630-668-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number042004915
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARYN T ABRAHAM JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-668-9610