Healthcare Provider Details

I. General information

NPI: 1235111824
Provider Name (Legal Business Name): WESTERN SPRINGS ASTHMA & ALLERGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 WOLF RD SUITE 135
WESTERN SPRINGS IL
60558-2254
US

IV. Provider business mailing address

5600 WOLF RD SUITE 135
WESTERN SPRINGS IL
60558-2254
US

V. Phone/Fax

Practice location:
  • Phone: 708-246-4515
  • Fax: 708-246-4502
Mailing address:
  • Phone: 708-246-4515
  • Fax: 708-246-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RENEE LANTNER
Title or Position: PRESIDENT
Credential: MD
Phone: 708-246-4515