Healthcare Provider Details

I. General information

NPI: 1992890891
Provider Name (Legal Business Name): ALLERGY SPECILAISTS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5434 W CAPITOL DR
MILWAUKEE WI
53216
US

IV. Provider business mailing address

890 ELM GROVE RD STE211
ELM GROVE WI
53122
US

V. Phone/Fax

Practice location:
  • Phone: 414-761-7000
  • Fax:
Mailing address:
  • Phone: 414-761-7000
  • Fax: 262-784-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RUCHIR AGRAWAL
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 414-761-7000