| Southtown Allergy And Asthma Care, Pc | |
|
18210 La Grange Rd Suite 201 Tinley Park IL 60487-7722 | |
| (708) 945-6328 | |
| Not Available |
| Full Name | Southtown Allergy And Asthma Care, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 18210 La Grange Rd, Tinley Park, Illinois |
| Authorized Official Name and Position | Miguel Jaen Alcordo (PRESIDENT) |
| Authorized Official Contact | 7089456328 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southtown Allergy And Asthma Care, Pc 18210 La Grange Rd Suite 201 Tinley Park IL 60487-7722 Ph: (708) 945-6328 | Southtown Allergy And Asthma Care, Pc 18210 La Grange Rd Suite 201 Tinley Park IL 60487-7722 Ph: (708) 945-6328 |
| NPI Number | 1396916409 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 12/06/2010 |
| Medicare PECOS PAC ID | 4880881002 |
|---|---|
| Medicare Enrollment ID | O20101214000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396916409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036083285 (Illinois) | Primary |
| Provider Name | Miguel Jaen Alcordo |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1477553899 PECOS PAC ID: 2264328384 Enrollment ID: I20040225000964 |
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