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General NPI Number Information
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NPI Number | 1396916409
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Entity Type | Organization
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Legal Business Name | SOUTHTOWN ALLERGY AND ASTHMA CARE, PC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 18210 LA GRANGE RD SUITE 201
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City | TINLEY PARK
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State | IL
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Zip | 60487-7722
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Country | US
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Telephone | 708-945-6328
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Fax |
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Provider Business Mailing Address
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Address Line | 18210 LA GRANGE RD STE 201
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City | TINLEY PARK
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State | IL
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Zip | 60487-7725
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Country | US
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Telephone | 708-945-6328
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Fax | 708-478-1286
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Authorized Official
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Title or Position | MD
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Name | DR. MIGUEL JAEN ALCORDO
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Credential |
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Telephone | 708-945-6332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 036083285
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License Number State | IL
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