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General NPI Number Information
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NPI Number | 1508066960
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Entity Type | Organization
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Legal Business Name | ALLERGY & CL IMMUNOLOGY CENTER
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 1425 N MCLEAN BLVD SUITE 100
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City | ELGIN
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State | IL
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Zip | 60123-5723
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Country | US
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Telephone | 847-931-1999
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Fax | 847-931-1721
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Provider Business Mailing Address
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Address Line | 10001 W ROOSEVELT RD SUITE 304
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City | WESTCHESTER
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State | IL
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Zip | 60154-2664
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Country | US
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Telephone | 708-344-3550
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Fax | 708-344-6577
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMAD TK GHANI
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Credential | M.D.
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Telephone | 708-344-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 036050567
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License Number State | IL
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