Healthcare Provider Details

I. General information

NPI: 1588743645
Provider Name (Legal Business Name): WARREN ALLERGY & ASTHMA CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37130 HOOVER RD SUITE A
WARREN MI
48093
US

IV. Provider business mailing address

31730 HOOVER RD SUITEA
WARREN MI
48093-1700
US

V. Phone/Fax

Practice location:
  • Phone: 586-268-9222
  • Fax: 586-268-9226
Mailing address:
  • Phone: 586-268-9222
  • Fax: 586-268-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301067218
License Number StateMI

VIII. Authorized Official

Name: DR. JANE E KRASNICK
Title or Position: OWNER
Credential: M.D.
Phone: 586-268-9222