Healthcare Provider Details

I. General information

NPI: 1811013212
Provider Name (Legal Business Name): AGGARWAL ALLERGY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW MURRAY RD SUITE 306
LEES SUMMIT MO
64081-1204
US

IV. Provider business mailing address

PO BOX 18259
RAYTOWN MO
64133-8259
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-8400
  • Fax: 816-525-8411
Mailing address:
  • Phone: 816-525-8400
  • Fax: 816-525-8411

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. JAG M AGGARWAL
Title or Position: OWNER
Credential: M.D.
Phone: 816-525-8400