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General NPI Number Information
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NPI Number | 1699808196
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE INTERNAL MEDICINE SPECIALISTS, SC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2645 N MAYFAIR RD STE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-1304
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Country | US
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Telephone | 414-479-1800
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Fax | 414-479-1813
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Provider Business Mailing Address
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Address Line | 2645 N MAYFAIR RD STE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-1304
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Country | US
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Telephone | 414-479-1800
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Fax | 414-479-1813
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW C KIM
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Credential | MD
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Telephone | 414-479-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | WI
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