Organization
BLOOMINGTON PEDIATRICS AND ALLERGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN LYNNE LABOUNTY (OFFICE MANAGER)
(309) 663-2354
Entity
Organization
Contact information
Practice address
306 SAINT JOSEPH DR, BLOOMINGTON, IL 61701-3506
(309) 663-2354
(309) 662-8602
Mailing address
306 SAINT JOSEPH DR, BLOOMINGTON, IL 61701-3506
(309) 663-2354
(309) 662-8602
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036058820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058820
—
IL
05
—
036060449
—
IL
05
—
036075395
—
IL
05
—
036078523
—
IL
05
—
036090475
—
IL
05
—
036094964
—
IL
05
—
036097491
—
IL
05
—
036115725
—
IL
Enumeration date
09/10/2007
Last updated
03/27/2009
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