MEDICARE: AFFILIATED EAR, NOSE AND THROAT PHYSICIANS

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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1619012010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED EAR, NOSE AND THROAT PHYSICIANS

Provider Business Mailing Address
First Line	:	2441 LAKE SHORE DR
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-6911
Country	:	US
Telephone Number	:	815-338-4600
Fax Number	:	815-338-4611

Provider Business Practice Location Address
First Line	:	214 WASHINGTON ST
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041-9208
Country	:	US
Telephone Number	:	847-587-4700
Fax Number	:	847-587-6034

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	FAY WILSON
Credential	:
Telephone Number	:	815-338-4600

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	06/16/2008

Similar Medicare Providers

1053417741 — SUNSHINE PEDIATRICS, S.C.
Practice Location Address:

214 WASHINGTON ST , STE 3
INGLESIDE, IL
60041-9208

Practice Phone: 847-587-9090
Practice Fax: 847-587-9093

1609095678 — DR. MIN JUNG KWON D.D.S.
Practice Location Address:

214 WASHINGTON ST
INGLESIDE, IL
60041-9208

Practice Phone: 847-587-3020
Practice Fax: 847-587-1598

1992905921 — MR. JOO HAN KWON DDS
Practice Location Address:

214 WASHINGTON ST
INGLESIDE, IL
60041-9208

Practice Phone: 847-587-3020
Practice Fax: 847-587-1598

1134376189 — WESTLAKE DENTAL CENTER
Practice Location Address:

214 WASHINGTON ST
INGLESIDE, IL
60041-9208

Practice Phone: 847-587-3020
Practice Fax: 847-587-1598

1760632459 — WILLIAM C. DAM, M.D.S.C.
Practice Location Address:

214 WASHINGTON ST
INGLESIDE, IL
60041-9208

Practice Phone: 847-587-3004
Practice Fax: 847-587-4325

1699053967 — FOX LAKE FOOT CARE LTD
Practice Location Address:

214 WASHINGTON ST , SUITE #3
INGLESIDE, IL
60041-9208

Practice Phone: 847-587-3221
Practice Fax: 847-587-2148

Directions to “AFFILIATED EAR, NOSE AND THROAT PHYSICIANS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.