=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982273413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRENGTH TO LOVE FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2021
-----------------------------------------------------
Last Update Date | 06/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2136 W BELMONT AVE STE 1
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-6435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-625-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2709 N HERMITAGE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60614-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-888-1475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID AARON NAYAK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 312-888-1475
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------