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General NPI Number Information
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NPI Number | 1225234206
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Entity Type | Organization
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Legal Business Name | ALLERGY AND ASTHMA CARECENTER SC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 120 NE GLEN OAK AVE SUITE 408
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City | PEORIA
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State | IL
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Zip | 61603-4314
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Country | US
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Telephone | 309-672-3158
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Fax | 309-672-3114
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Provider Business Mailing Address
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Address Line | 120 NE GLEN OAK AVE SUITE 408
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City | PEORIA
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State | IL
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Zip | 61603-4314
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Country | US
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Telephone | 309-672-3158
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Fax | 309-672-3114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL W PALMER
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Credential | MD
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Telephone | 309-672-3158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 042.007061036.047262
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License Number State | IL
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