MEDICARE: INNOVATIVE ALLERGY

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	N4167	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1427541101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE ALLERGY

Provider Business Mailing Address
First Line	:	6550 MAPLERIDGE ST STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4629
Country	:	US
Telephone Number	:	281-701-5457
Fax Number	:	281-605-6815

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4629
Country	:	US
Telephone Number	:	281-701-5457
Fax Number	:	281-605-6815

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DAT QUOC TRAN
Credential	:	MD
Telephone Number	:	281-701-5457

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	05/03/2026

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Directions to “INNOVATIVE ALLERGY ” Practice Location

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