Healthcare Provider Details

I. General information

NPI: 1528152246
Provider Name (Legal Business Name): ALLERGY & ASTHMA MANAGEMENT CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY SUITE 310
NOVI MI
48374-1209
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY SUITE 310
NOVI MI
48374-1209
US

V. Phone/Fax

Practice location:
  • Phone: 248-380-9630
  • Fax: 248-380-3459
Mailing address:
  • Phone: 248-380-9630
  • Fax: 248-380-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberRB069790
License Number StateMI

VIII. Authorized Official

Name: ROLA BOKHARI PANZA
Title or Position: PRESIDENT
Credential: MD
Phone: 248-478-6300