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WESTERN ILLINOIS ENT AND ALLERGY NPI 1689751356


NPI Information

NPI: 1689751356
Provider Name: WESTERN ILLINOIS ENT AND ALLERGY
Classification: Allergy & Immunology - 207KA0200X
Entity Type: Organization

Specialization: Allergy

Address:
104 W 6TH ST
SUITE 303
STREATOR, IL
ZIP 61364
Phone: (815) 673-6368
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WESTERN ILLINOIS ENT AND ALLERGY is an allergy allergy immunology in Streator, IL. The provider is a physician who specializes in the diagnosis, treatment, and management of allergies. Source: National Uniform Claim Committee WESTERN ILLINOIS ENT AND ALLERGY NPI is 1689751356. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

104 W 6TH ST
SUITE 303
STREATOR, IL
ZIP 61364-899
Phone: (815) 673-6368
Fax: (866) 262-4460

The provider's authorized official is Charles Dickerson .
The authorized official title is Owner and has the following contact phone number (815) 673-6368.

The enumeration date for this NPI number is 11/1/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207KA0200XAllergy & ImmunologyAllergy36055109ILLINOISYes
2207Y00000XOtolaryngology36055109ILLINOISX

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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