MEDICARE: ALLERGY ASTHMA AND IMMUNOLOGY

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	363L00000X	Nurse Practitioner

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	:	1790816957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY ASTHMA AND IMMUNOLOGY

Provider Business Mailing Address
First Line	:	1019 MAJESTIC DR STE 210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1947
Country	:	US
Telephone Number	:	859-277-3114
Fax Number	:	859-275-1942

Provider Business Practice Location Address
First Line	:	1019 MAJESTIC DR STE 210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1947
Country	:	US
Telephone Number	:	859-277-3114
Fax Number	:	859-275-1942

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ELENI LIVAS
Credential	:
Telephone Number	:	859-277-3114

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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