Organization
ALLERGY & CL IMMUNOLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD TARIQ GHANI MD (PRESIDENT)
(847) 931-1999
Entity
Organization
Contact information
Practice address
10001 W ROOSEVELT RD, SUITE 304, WESTCHESTER, IL 60154-2664
(708) 344-3550
(708) 344-6577
Mailing address
10001 W ROOSEVELT RD, SUITE 304, WESTCHESTER, IL 60154-2664
(708) 344-3550
(708) 344-6577
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
036050567
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617646
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
06/24/2008
Last updated
10/07/2008
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