Healthcare Provider Details

I. General information

NPI: 1891931689
Provider Name (Legal Business Name): ALLERGY & ARTHRITIS TREATMENT CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2008
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22226 WESTCHESTER BLVD
PORT CHARLOTTE FL
33952-9202
US

IV. Provider business mailing address

22226 WESTCHESTER BLVD
PORT CHARLOTTE FL
33952-9202
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-3402
  • Fax:
Mailing address:
  • Phone: 941-625-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number3658046
License Number StateFL

VIII. Authorized Official

Name: DR. LESLIE TAR
Title or Position: MEMBER
Credential: MD, MPH
Phone: 941-625-3402