MEDICARE: ALLERGY AND IMMUNOLOGY CONSULTANTS LLC

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

General Provider Information

NPI Number	:	1871379834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY AND IMMUNOLOGY CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 38
Second Line	:
City	:	OTTAWA LAKE
State	:	MI
Zip	:	49267-0038
Country	:	US
Telephone Number	:	419-540-8556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 NAVARRE AVE UNIT 203
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3275
Country	:	US
Telephone Number	:	419-540-8556
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	AYMAN AOUTHMANY
Credential	:	MD
Telephone Number	:	419-540-8556

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	11/30/2023

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