14D2166293 CLIA NUMBER - ASTHMA & ALLERGY IMMUNOLOGY

Laboratory Demographics

CLIA Number: 14D2166293

Facility Name: ASTHMA & ALLERGY IMMUNOLOGY

Facility Address:
303 E ARMY TRAIL RD - STE 403
BLOOMINGDALE, IL
ZIP 60108
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Facility Phone Number: 630 894-7083

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760513725

Taxonomy: 207KA0200X - Allergy & Immunology
A physician who specializes in the diagnosis, treatment, and management of allergies. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	14D2166293
LAB Type	Physician Office
Facility Name	ASTHMA & ALLERGY IMMUNOLOGY
Street	303 E ARMY TRAIL RD - STE 403
City	BLOOMINGDALE
State	IL
ZIP	60108
Phone	630 894-7083
CertificateType	4
CertificateEffectiveDate	5/15/2023
CertificateExpirationDate	5/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024