1992890891 NPI number — ALLERGY SPECILAISTS, SC

Table of content: (NPI 1992890891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992890891 NPI number — ALLERGY SPECILAISTS, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY SPECILAISTS, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992890891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 ELM GROVE RD STE211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELM GROVE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-761-7000
Provider Business Mailing Address Fax Number:
262-784-5472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5434 W CAPITOL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-761-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AGRAWAL
Authorized Official First Name:
RUCHIR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
414-761-7000

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34123200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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