MEDICARE: CANTON ASTHMA & ALLERGY PC

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
2	2080P0201X	Pediatric Allergy/Immunology Physician

General Provider Information

NPI Number	:	1487715157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON ASTHMA & ALLERGY PC

Provider Business Mailing Address
First Line	:	1600 S CANTON CENTER RD STE 360
Second Line	:	CANTON ASTHMA & ALLERGY
City	:	CANTON
State	:	MI
Zip	:	48188-0004
Country	:	US
Telephone Number	:	734-394-2661
Fax Number	:	734-394-2666

Provider Business Practice Location Address
First Line	:	1600 S CANTON CENTER RD STE 360
Second Line	:	CANTON ASTHMA & ALLERGY
City	:	CANTON
State	:	MI
Zip	:	48188-0004
Country	:	US
Telephone Number	:	734-394-2661
Fax Number	:	734-394-2666

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JACQUELYN A ARZOOYAN
Credential	:
Telephone Number	:	734-394-2661

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/20/2018

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