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General NPI Number Information
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NPI Number | 1245373976
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Entity Type | Organization
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Legal Business Name | ALLERGY SPECIALISTS
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 890 ELM GROVE RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2528
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Country | US
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Telephone | 414-761-7000
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Fax | 262-784-5472
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Provider Business Mailing Address
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Address Line | 2603 W RAWSON AVE
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City | OAK CREEK
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State | WI
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Zip | 53154-8422
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Country | US
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Telephone | 414-761-7000
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Fax | 262-784-5472
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Authorized Official
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Title or Position | OWNER
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Name | RUCHIR AGRAWAL
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Credential | M.D.
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Telephone | 414-761-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 43581020
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License Number State | WI
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