Advanced Allergy & Ent, LLC
Otolaryngology in Rockford, IL. Organization (NPI-2).
NPI number1346449022
StatusActive
Last updated in NPPESSep 28, 2007
Details
- NPI
- 1346449022
- Entity type
- Organization (NPI-2)
- Legal business name
- Advanced Allergy & Ent, LLC
- Organization subpart
- No
- Enumeration date
- Jul 13, 2007
- Last updated
- Sep 28, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Y00000X | Otolaryngology | 036104814 | IL | Yes |
| 207KA0200X | Allergy & Immunology, Allergy | 036104814 | IL | |
| 207YX0905X | Otolaryngology, Otolaryngology/Facial Plastic Surgery | 036104814 | IL | |
| 207YX0007X | Otolaryngology, Plastic Surgery within the Head & Neck | 036104814 | IL |
Practice location
1235 N Mulford RdSuite 100
Rockford, IL 61107-3879
Phone 815-484-9900
Mailing address
1235 N Mulford RdSuite 100
Rockford, IL 61107-3879
Phone 815-484-9900
Authorized official
Andrew I Jun
President/Ceo
8152221900
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