Provider Demographics
NPI:1427060540
Name:MIDWEST ALLERGY & SINUS CENTER, LLC
Entity type:Organization
Organization Name:MIDWEST ALLERGY & SINUS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-651-4278
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2063
Mailing Address - Country:US
Mailing Address - Phone:317-770-0055
Mailing Address - Fax:317-770-0066
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2600
Practice Address - Country:US
Practice Address - Phone:765-651-4248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center