MEDICARE: MIDWEST ALLERGY ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF1390	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396716361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ALLERGY ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	8080 RAVINES EDGE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5424
Country	:	US
Telephone Number	:	614-846-5944
Fax Number	:	614-846-6504

Provider Business Practice Location Address
First Line	:	8080 RAVINES EDGE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5424
Country	:	US
Telephone Number	:	614-846-5944
Fax Number	:	614-846-6504

Authorized Official
Title or Position	:	ADM. ASST.
Name	:	SHANNON FRECHEN
Credential	:
Telephone Number	:	614-846-5944

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/12/2020

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Directions to “MIDWEST ALLERGY ASSOCIATES, INC. ” Practice Location

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