=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346299005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASTHMA ALLERGY CARE CENTER PL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 12/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301, S. INTERNATIONAL PARKWAY SUITE 1011
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-804-6002
-----------------------------------------------------
Fax | 407-804-8777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301, S. INTERNATIONAL PARKWAY SUITE 1011
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-804-6002
-----------------------------------------------------
Fax | 407-804-8777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAJESH KACHARALAL PATEL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-804-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0201X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
-----------------------------------------------------
License Number | ME0062618
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0201X
-----------------------------------------------------
Taxonomy Name | Pediatric Allergy/Immunology Physician
-----------------------------------------------------
License Number | ME0062618
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | ME0062618
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number | ME0062618
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------