Healthcare Provider Details

I. General information

NPI: 1770878951
Provider Name (Legal Business Name): ALLERGY & IMMUNOLOGY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WESTLAKE DR STE 104
WEST LAKE HILLS TX
78746-5373
US

IV. Provider business mailing address

102 WESTLAKE DR STE 104
WEST LAKE HILLS TX
78746-5373
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-5911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: OJAS PATEL
Title or Position: PRESIDENT
Credential:
Phone: 512-454-5911