MEDICARE: LIVINGSTON CENTER OF ALLERGY, SINUS & ASTHMA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	AD060576	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033203674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSTON CENTER OF ALLERGY, SINUS & ASTHMA, PC

Provider Business Mailing Address
First Line	:	P O BOX 30516
Second Line	:	DEPT 8650
City	:	LANSING
State	:	MI
Zip	:	48909-8016
Country	:	US
Telephone Number	:	810-227-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	8546 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-227-0906
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNA DOBRACKI
Credential	:	MD
Telephone Number	:	810-227-0906

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/25/2014

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