MEDICARE: ALLERGY & ASTHMA SPECIALISTS, PA

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	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician

General Provider Information

NPI Number	:	1487614590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY & ASTHMA SPECIALISTS, PA

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1149
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-338-3333
Fax Number	:	612-349-3838

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1149
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-338-3333
Fax Number	:	612-349-3838

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. GARY D. BERMAN
Credential	:	M.D.
Telephone Number	:	612-338-3333

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	02/02/2010

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