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General NPI Number Information
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NPI Number | 1891729737
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Entity Type | Organization
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Legal Business Name | ALLERGY, ASTHMA AND IMMUNOLOGY CLINIC, P.A.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 4625 CHURCHILL ST SUITE 211
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City | SHOREVIEW
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State | MN
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Zip | 55126-5868
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Country | US
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Telephone | 651-765-9800
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Fax | 651-765-9801
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Provider Business Mailing Address
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Address Line | 4625 CHURCHILL ST SUITE 211
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City | SHOREVIEW
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State | MN
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Zip | 55126-5868
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Country | US
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Telephone | 651-765-9800
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Fax | 651-765-9801
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AUDREY D CECKO
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Credential |
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Telephone | 651-765-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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