Healthcare Provider Details

I. General information

NPI: 1376040360
Provider Name (Legal Business Name): ORANDI ALLERGY AND ASTHMA CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 HEALTH DR SW STE 1400
WYOMING MI
49519
US

IV. Provider business mailing address

PO BOX 3140
GRAND RAPIDS MI
49501-3140
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-6301
  • Fax: 616-504-1702
Mailing address:
  • Phone: 616-459-6867
  • Fax: 616-726-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301095171
License Number StateMI

VIII. Authorized Official

Name: DARIUSH J ORANDI
Title or Position: OWNER
Credential: MD
Phone: 616-794-6301