Organization
MIDWEST SINUS SLEEP & ALLERGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI BLAGG (OFFICE MANAGER)
(618) 628-0715
Entity
Organization
Contact information
Practice address
4224 LINCOLNSHIRE DR STE B, MOUNT VERNON, IL 62864-2156
(618) 816-0715
(888) 371-4468
Mailing address
4224 LINCOLNSHIRE DR STE B, MOUNT VERNON, IL 62864-2156
(618) 816-0715
(888) 371-4468
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137681642
NEW ENTITY
IL
Enumeration date
10/15/2020
Last updated
01/04/2021
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