OrganizationActive
Affiliated Ear, Nose and Throat Physicians
NPI 1619012010 · Otolaryngology Physician · Ingleside, IL
Provider details
- NPI number
- 1619012010
- Entity type
- Organization
- Primary specialty
- Otolaryngology PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Fay Wilson, Practice Manager
Practice location
214 Washington St
Ingleside, IL 60041-9208
Phone: (847) 587-4700
Fax: (847) 587-6034
Mailing address
2441 Lake Shore Dr
Woodstock, IL 60098-6911
Registry dates
- Enumerated
- 2007-02-21
- Last updated
- 2008-06-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.