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General NPI Number Information
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NPI Number | 1861503153
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Entity Type | Organization
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Legal Business Name | ASTHMA AND ALLERGY CENTER OF CHICAGO SC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 7420 CENTRAL AVE SUITE 2020
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City | RIVER FOREST
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State | IL
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Zip | 60305-1800
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Country | US
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Telephone | 708-366-9300
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Fax | 708-366-9310
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Provider Business Mailing Address
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Address Line | 7420 CENTRAL AVE SUITE 2020
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City | RIVER FOREST
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State | IL
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Zip | 60305-1800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. EDWARD E LISBERG
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Credential | MD
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Telephone | 708-366-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036067746
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 036067746
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License Number State | IL
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