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Organization

WESTERN ILLINOIS ENT AND ALLERGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHARLES DICKERSON MD (OWNER)
(815) 673-6368
Entity
Organization

Contact information

Practice address
104 W 6TH ST, SUITE 303, STREATOR, IL 61364-2899
(815) 673-6368
(866) 262-4460
Mailing address
104 W 6TH ST, SUITE 303, STREATOR, IL 61364-2899
(815) 673-6368
(866) 262-4460

Taxonomy

Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
36055109
IL
207Y00000X
Otolaryngology Physician
Primary
36055109
IL

Other

Enumeration date
11/01/2006
Last updated
09/11/2025
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