MEDICARE: ALLERGY & CLINICAL IMMUNOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	036-0505567	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	216213036	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1215197546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY & CLINICAL IMMUNOLOGY INC

Provider Business Mailing Address
First Line	:	7808 W COLLEGE DR
Second Line	:	SUITE 1SW
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1027
Country	:	US
Telephone Number	:	708-361-0730
Fax Number	:	708-361-0740

Provider Business Practice Location Address
First Line	:	7808 W COLLEGE DR
Second Line	:	SUITE 1SW
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1027
Country	:	US
Telephone Number	:	708-361-0730
Fax Number	:	708-361-0740

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMAD TARIQ GHANI
Credential	:	MD
Telephone Number	:	708-361-0730

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	10/14/2008

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Directions to “ALLERGY & CLINICAL IMMUNOLOGY INC ” Practice Location

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