Healthcare Provider Details

I. General information

NPI: 1699829192
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTERS,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MAYFAIR RD SUITE 220
WAUWATOSA WI
53226-1409
US

IV. Provider business mailing address

8104 BROOKSIDE PL
WAUWATOSA WI
53213-3318
US

V. Phone/Fax

Practice location:
  • Phone: 414-475-9101
  • Fax: 414-475-9203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TERRY S GRAVES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-475-9101