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General NPI Number Information
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NPI Number | 1477545200
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Entity Type | Organization
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Legal Business Name | DEARBORN ALLERGY & ASTHMA CLINIC PC
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 20200 OUTER DR
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City | DEARBORN
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State | MI
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Zip | 48124-2634
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Country | US
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Telephone | 313-565-3565
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Fax | 313-565-7723
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Provider Business Mailing Address
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Address Line | 20200 OUTER DR
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City | DEARBORN
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State | MI
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Zip | 48124-2634
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Country | US
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Telephone | 313-565-3565
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Fax | 313-565-7723
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KATHY SHORT
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Credential |
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Telephone | 313-565-3565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KI0005X
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Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
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License Number |
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License Number State |
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