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General NPI Number Information
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NPI Number | 1578198396
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Entity Type | Organization
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Legal Business Name | MIDWEST ALLERGY ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 6275 E BROAD ST STE 100
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City | COLUMBUS
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State | OH
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Zip | 43213-1504
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Country | US
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Telephone | 614-759-4730
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Fax | 614-759-4731
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Provider Business Mailing Address
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Address Line | 8080 RAVINES EDGE CT STE 100
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City | COLUMBUS
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State | OH
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Zip | 43235-5424
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Country | US
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Telephone | 614-846-5944
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Fax | 614-846-6504
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI KNISLEY
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Credential |
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Telephone | 614-846-5944
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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 |
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License Number State |
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