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General NPI Number Information
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NPI Number | 1740340447
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Entity Type | Organization
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Legal Business Name | LOUISVILLE ALLERGY & ASTHMA, PSC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 4402 CHURCHMAN AVE SUITE 401
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City | LOUISVILLE
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State | KY
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Zip | 40215-1190
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Country | US
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Telephone | 502-363-8624
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Fax | 502-363-7059
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Provider Business Mailing Address
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Address Line | 4402 CHURCHMAN AVE SUITE 401
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City | LOUISVILLE
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State | KY
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Zip | 40215-1190
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Country | US
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Telephone | 502-363-8624
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Fax | 502-363-7059
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID PALLARES
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Credential | M.D.
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Telephone | 502-363-8624
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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 | 27337
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License Number State | KY
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