Healthcare Provider Details

I. General information

NPI: 1437313475
Provider Name (Legal Business Name): ALLIANCE PULMONARY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 LOUISVILLE STREET NE
LOUISVILLE OH
44641
US

IV. Provider business mailing address

PO BOX 2749
ALLIANCE OH
44601-0749
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-7400
  • Fax: 330-823-6449
Mailing address:
  • Phone: 330-829-9389
  • Fax: 330-829-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35078091
License Number StateOH

VIII. Authorized Official

Name: ABDUL BASIT
Title or Position: PHYSICIAN
Credential: MD
Phone: 330-821-7400