Western Illinois ENT and Allergy

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

36055109 Issued in IL

Legal business name

WESTERN ILLINOIS ENT AND ALLERGY

Practice address

104 W 6TH St
Suite 303
Streator, IL 61364-2899

Phone

(815) 673-6368

Fax

(866) 262-4460

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles Dickerson, MD

Title

Owner

Phone

(815) 673-6368

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1689751356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W 6TH ST",
            "address_2": "SUITE 303",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642899",
            "telephone_number": "815-673-6368",
            "fax_number": "866-262-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W 6TH ST",
            "address_2": "SUITE 303",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642899",
            "telephone_number": "815-673-6368",
            "fax_number": "866-262-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN ILLINOIS ENT AND ALLERGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-673-6368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "IL",
            "license": "36055109",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "36055109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Streator, IL
• Providers in Streator, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.