Healthcare Provider Details

I. General information

NPI: 1356435978
Provider Name (Legal Business Name): VALLEY ALLERGY CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 HALLMARK COURT
SAGINAW MI
48603-2108
US

IV. Provider business mailing address

3210 HALLMARK COURT
SAGINAW MI
48603-2108
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-9490
  • Fax: 989-799-4639
Mailing address:
  • Phone: 989-799-9490
  • Fax: 989-799-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY ALAN SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-799-9490