=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073608162
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST SUBURBAN INFECTIOUS DISEASE SPECIALISTS SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 SUPERIOR ST STE 409
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60160-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-410-2880
-----------------------------------------------------
Fax | 708-410-2884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 SUPERIOR ST STE 409
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60160-4159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-410-2880
-----------------------------------------------------
Fax | 708-410-2884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NAUSICA D'ALFONSO- LAGHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 630-267-4255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 042617977
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------