Healthcare Provider Details

I. General information

NPI: 1295722445
Provider Name (Legal Business Name): ALLERGY & ASTHMA SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N CLOVERLEAF DR SUITE G
SAINT PETERS MO
63376-6436
US

IV. Provider business mailing address

10, CONWAY SPRINGS DRIVE
CHESTERFIELD MO
63017-3411
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-1232
  • Fax:
Mailing address:
  • Phone: 636-928-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number34881
License Number StateMO

VIII. Authorized Official

Name: MOHAMMAD H. RAHMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 636-828-1232