Organization
ASTHMA AND ALLERGY CENTER OF CHICAGO SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD E LISBERG MD (DIRECTOR)
(708) 366-9300
Entity
Organization
Contact information
Practice address
7420 CENTRAL AVE, SUITE 2020, RIVER FOREST, IL 60305-1800
(708) 366-9300
(708) 366-9310
Mailing address
7420 CENTRAL AVE, SUITE 2020, RIVER FOREST, IL 60305-1800
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
036067746
IL
207R00000X
Internal Medicine Physician
036067746
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067746
—
IL
01
—
31603461
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/31/2006
Last updated
11/30/2009
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