Healthcare Provider Details

I. General information

NPI: 1841454063
Provider Name (Legal Business Name): ALLERGIC DISEASE AND ASTHMA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E BUTLER RD
GREENVILLE SC
29607-5910
US

IV. Provider business mailing address

PO BOX 27129
GREENVILLE SC
29616-2129
US

V. Phone/Fax

Practice location:
  • Phone: 864-627-3800
  • Fax: 864-672-2653
Mailing address:
  • Phone: 864-627-3800
  • Fax: 864-672-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL W. REDER
Title or Position: MEDICAL PHYSICIAN
Credential: MD
Phone: 864-269-0386