MEDICARE: ASTHMA AND ALLERGY CENTER LTD.

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	207KA0200X	Allergy Physician	90106	OH

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	:	1720271869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTHMA AND ALLERGY CENTER LTD.

Provider Business Mailing Address
First Line	:	3040 BELMONT AVE
Second Line	:	SUITE A
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1836
Country	:	US
Telephone Number	:	330-759-3415
Fax Number	:	330-759-9215

Provider Business Practice Location Address
First Line	:	3040 BELMONT AVE
Second Line	:	SUITE A
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1836
Country	:	US
Telephone Number	:	330-759-3415
Fax Number	:	330-759-9215

Authorized Official
Title or Position	:	MANAGING MEMBER/PRESIDENT
Name	:	DR. ASIF IQBAL KHAN
Credential	:	M.D.
Telephone Number	:	440-796-5207

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	09/17/2008

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