MEDICARE: PROGRESSIVE INSTITUTE OF ALLERGY, 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	207KA0200X	Allergy Physician

General Provider Information

NPI Number	:	1457479420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE INSTITUTE OF ALLERGY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 301046
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4546
Country	:	US
Telephone Number	:	773-485-1958
Fax Number	:	773-427-7865

Provider Business Practice Location Address
First Line	:	5351 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3627
Country	:	US
Telephone Number	:	773-485-1958
Fax Number	:	773-427-7865

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN FROELICH
Credential	:	R.N.
Telephone Number	:	773-485-1958

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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