Organization · NPI-2
Allergy & Asthma Of Illinois Sc
Allergy & Immunology · Peoria, IL
NPI number1194712547
StatusActive
Last updated in NPPESJan 26, 2010
Details
- NPI
- 1194712547
- Entity type
- Organization (NPI-2)
- Legal business name
- Allergy & Asthma Of Illinois Sc
- Organization subpart
- No
- Enumeration date
- Sep 30, 2005
- Last updated
- Jan 26, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207K00000X | Allergy & Immunology | 042008003 | IL | Yes |
Practice location
6615 N Big Hollow RdPeoria, IL 61615-2450
Phone 309-691-5200 · Fax 309-691-5201
Mailing address
6615 N Big Hollow RdPeoria, IL 61615-2450
Phone 309-691-5200 · Fax 309-691-5201
Authorized official
Stephen J Smart
President
3096915200
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