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General NPI Number Information
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NPI Number | 1073619193
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Entity Type | Organization
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Legal Business Name | ALLERGY & ASTHMA CLINIC PLLC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 814 N MACOMB ST
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City | MONROE
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State | MI
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Zip | 48162-2930
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Country | US
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Telephone | 734-242-2255
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Fax | 734-243-9261
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Provider Business Mailing Address
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Address Line | 814 N MACOMB ST
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City | MONROE
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State | MI
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Zip | 48162-2930
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Country | US
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Telephone | 734-242-2255
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Fax | 734-243-9261
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Authorized Official
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Title or Position | PARTNERSHIP
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Name | KANTI HIRALAL SHAH
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Credential | M.D.
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Telephone | 734-242-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 4301032767
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License Number State | MI
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