Healthcare Provider Details

I. General information

NPI: 1003687385
Provider Name (Legal Business Name): ELITE ALLERGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 E CEDAR AVE
GLADWIN MI
48624-7004
US

IV. Provider business mailing address

PO BOX 7415
BLOOMFIELD HILLS MI
48302-7415
US

V. Phone/Fax

Practice location:
  • Phone: 989-701-2159
  • Fax: 989-701-2158
Mailing address:
  • Phone: 989-343-5037
  • Fax: 877-569-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HASSAN NASIR
Title or Position: OWNER
Credential: DO
Phone: 248-890-8711