Provider Demographics
NPI:1730228610
Name:ALLERGY & ASTHMA CENTER, INC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-729-9900
Mailing Address - Street 1:2228 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-0928
Mailing Address - Country:US
Mailing Address - Phone:815-729-9900
Mailing Address - Fax:815-729-9913
Practice Address - Street 1:2913 N COMMONWEALTH AVE FL 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6211
Practice Address - Country:US
Practice Address - Phone:815-729-9900
Practice Address - Fax:815-729-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-066748261Q00000X
207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066748Medicaid
IL4047673OtherCIGNA
IL794184OtherFIRST HEALTH
IL31603308OtherBLUE CROSS
IL788313OtherUNITED HEALTH CARE
IL941760Medicare ID - Type Unspecified