=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285830935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARCHANA R NARAYAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 N HAMMES AVE
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-8100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-744-2300
-----------------------------------------------------
Fax | 815-744-9208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 N HAMMES AVE
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-8100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-744-2300
-----------------------------------------------------
Fax | 815-744-9208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number | 036118762
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------