Healthcare Provider Details

I. General information

NPI: 1346299005
Provider Name (Legal Business Name): ASTHMA ALLERGY CARE CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301, S. INTERNATIONAL PARKWAY SUITE 1011
LAKE MARY FL
32746-1410
US

IV. Provider business mailing address

1301, S. INTERNATIONAL PARKWAY SUITE 1011
LAKE MARY FL
32746-1410
US

V. Phone/Fax

Practice location:
  • Phone: 407-804-6002
  • Fax: 407-804-8777
Mailing address:
  • Phone: 407-804-6002
  • Fax: 407-804-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME0062618
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0062618
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME0062618
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME0062618
License Number StateFL

VIII. Authorized Official

Name: RAJESH KACHARALAL PATEL
Title or Position: OWNER
Credential: M.D.
Phone: 407-804-6002