Healthcare Provider Details

I. General information

NPI: 1396950739
Provider Name (Legal Business Name): ILLINOIS INSTITUTE OF ALLERGY AND ASTHMA SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E. PHILLIP RD. SUITE 1105
VERNON HILLS IL
60061-1700
US

IV. Provider business mailing address

6 E. PHILLIP RD. SUITE 1105
VERNON HILLS IL
60061-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-0691
  • Fax: 847-362-0694
Mailing address:
  • Phone: 847-362-0691
  • Fax: 847-362-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036079245
License Number StateIL

VIII. Authorized Official

Name: DR. SCOTT I SONG
Title or Position: OWNER
Credential: M.D.
Phone: 847-362-0691