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General NPI Number Information
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NPI Number | 1750340949
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Entity Type | Organization
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Legal Business Name | EAR, NOSE & THROAT SPECIALISTS OF ILLINOIS LTD
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST STE 501
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City | PARK RIDGE
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State | IL
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Zip | 60068-8429
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Country | US
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Telephone | 847-674-5585
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Fax |
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Provider Business Mailing Address
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Address Line | 2604 DEMPSTER ST STE 501
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City | PARK RIDGE
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State | IL
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Zip | 60068-8429
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Country | US
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Telephone | 847-674-5585
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DAVID WALNER
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Credential |
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Telephone | 847-674-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 060-001273
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License Number State | IL
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