Healthcare Provider Details

I. General information

NPI: 1528332103
Provider Name (Legal Business Name): MICHIGAN ASTHMA AND ALLERGY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S ROCHESTER RD SUITE 3
ROCHESTER HILLS MI
48307-4598
US

IV. Provider business mailing address

2710 S ROCHESTER RD SUITE 3
ROCHESTER HILLS MI
48307-4598
US

V. Phone/Fax

Practice location:
  • Phone: 248-853-9097
  • Fax: 248-852-0347
Mailing address:
  • Phone: 248-853-9097
  • Fax: 248-852-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number4301071426
License Number StateMI

VIII. Authorized Official

Name: DR. GURSHARAN DHILLON
Title or Position: OWNER
Credential: M.D.
Phone: 248-853-9097