Healthcare Provider Details

I. General information

NPI: 1801422639
Provider Name (Legal Business Name): MIDWEST ALLERGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 W CHURCH ST
NEWARK OH
43055-1561
US

IV. Provider business mailing address

8080 RAVINES EDGE CT STE 100
COLUMBUS OH
43235-5424
US

V. Phone/Fax

Practice location:
  • Phone: 740-344-9484
  • Fax: 740-344-6366
Mailing address:
  • Phone: 614-846-5944
  • Fax: 614-846-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI KNISLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-846-5944