MEDICARE: ALLERGY & ASTHMA MEDICAL ASSOCIATES LTD

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	207K00000X	Allergy & Immunology Physician	042004915	IL
2	207KA0200X	Allergy Physician

General Provider Information

NPI Number	:	1396894812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY & ASTHMA MEDICAL ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	389 S SCHMALE RD
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2756
Country	:	US
Telephone Number	:	630-668-9610
Fax Number	:	630-668-9813

Provider Business Practice Location Address
First Line	:	2210 DEAN ST STE M
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-1059
Country	:	US
Telephone Number	:	630-668-9610
Fax Number	:	630-668-9813

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARYN T ABRAHAM JR.
Credential	:	M.D.
Telephone Number	:	630-668-9610

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/25/2023

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