Healthcare Provider Details

I. General information

NPI: 1154341618
Provider Name (Legal Business Name): ADULT AND CHILD ALLERGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 UNIVERSITY AVE W SUITE 450
SAINT PAUL MN
55104-3723
US

IV. Provider business mailing address

1690 UNIVERSITY AVE W SUITE 450
SAINT PAUL MN
55104-3723
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-8182
  • Fax: 651-649-3509
Mailing address:
  • Phone: 651-645-8182
  • Fax: 651-649-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number342
License Number StateMN

VIII. Authorized Official

Name: DR. WILLIAM EMMETT WALSH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 651-645-8182