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General NPI Number Information
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NPI Number | 1932380078
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Entity Type | Organization
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Legal Business Name | ALLERGY AND ASTHMA ASSOCIATES OF JOLIET, S.C.
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 2000 GLENWOOD AVE SUITE 100
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City | JOLIET
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State | IL
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Zip | 60435-5676
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Country | US
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Telephone | 815-741-1212
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Fax | 815-741-0707
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Provider Business Mailing Address
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Address Line | 2000 GLENWOOD AVE SUITE 100
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City | JOLIET
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State | IL
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Zip | 60435-5676
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Country | US
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Telephone | 815-741-1212
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Fax | 815-741-0707
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Authorized Official
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Title or Position | HEAD OF CORPORATION
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Name | DR. VORAPHOT SATHISSARAT
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Credential | MD
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Telephone | 815-741-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036046328
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License Number State | IL
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