Healthcare Provider Details

I. General information

NPI: 1477660009
Provider Name (Legal Business Name): ALLERGY RESEARCH & CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GREEN TREE ROAD
GLENDALE WI
53217-3815
US

IV. Provider business mailing address

350 GREEN TREE ROAD
GLENDALE WI
53217-3815
US

V. Phone/Fax

Practice location:
  • Phone: 262-754-5431
  • Fax: 262-784-5472
Mailing address:
  • Phone: 262-784-5431
  • Fax: 262-784-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number34325-020
License Number StateWI

VIII. Authorized Official

Name: ROBERT HENRI FISHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-784-5431