Healthcare Provider Details

I. General information

NPI: 1881746105
Provider Name (Legal Business Name): SIOUX CITY ALLERGY & ASTHMA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 SERGEANT RD SUITE 230
SIOUX CITY IA
51106-4634
US

IV. Provider business mailing address

4280 SERGEANT RD SUITE 230
SIOUX CITY IA
51106-4634
US

V. Phone/Fax

Practice location:
  • Phone: 712-274-6884
  • Fax:
Mailing address:
  • Phone: 712-274-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number23362
License Number StateIA

VIII. Authorized Official

Name: SANDY HAREN
Title or Position: OFFICE MANAGER
Credential:
Phone: 712-274-6884