Provider Demographics
NPI:1093720740
Name:ASTHMA, ALLERGY AND SINUS CENTER, PC
Entity Type:Organization
Organization Name:ASTHMA, ALLERGY AND SINUS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELJABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-648-4544
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:ATTN: LYNDA THOMPSON
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1108
Mailing Address - Country:US
Mailing Address - Phone:734-677-7400
Mailing Address - Fax:734-677-7407
Practice Address - Street 1:115 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1008
Practice Address - Country:US
Practice Address - Phone:810-648-4544
Practice Address - Fax:810-648-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICJ8012OtherRR MEDICARE
MI0N43860Medicare ID - Type UnspecifiedGROUP#