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General NPI Number Information
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NPI Number | 1710095385
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Entity Type | Organization
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Legal Business Name | ALLERGY AND ASTHMA CLINIC SC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 229 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-8100
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Country | US
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Telephone | 815-744-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 229 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-8100
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Country | US
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Telephone | 815-744-2300
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Fax |
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Authorized Official
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Title or Position | DR
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Name | THEODORE M KANELLAKES
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Credential | MD
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Telephone | 815-744-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State | IL
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