Healthcare Provider Details

I. General information

NPI: 1295996692
Provider Name (Legal Business Name): ALLERGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6294 1ST AVE N
ST PETERSBURG FL
33710-8414
US

IV. Provider business mailing address

6294 1 AVE N
ST. PETERSBURG FL
33710-8414
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-1900
  • Fax: 727-347-5273
Mailing address:
  • Phone: 727-345-1900
  • Fax: 727-347-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0044273
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME93707
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN J KLEMAWESCH
Title or Position: PRESIDENT
Credential: MD
Phone: 727-345-1900