Provider Demographics
NPI:1811976475
Name:OLIFF, IRMA M (MD)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:M
Last Name:OLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SKOKIE BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2856
Mailing Address - Country:US
Mailing Address - Phone:847-272-4296
Mailing Address - Fax:
Practice Address - Street 1:500 SKOKIE BLVD
Practice Address - Street 2:STE 140
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2856
Practice Address - Country:US
Practice Address - Phone:847-272-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099000207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099000Medicaid
L90318Medicare ID - Type Unspecified
IL036099000Medicaid