Provider Demographics
NPI:1104013846
Name:ALLERGY SLEEP AND LUNG CARE PA
Entity Type:Organization
Organization Name:ALLERGY SLEEP AND LUNG CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMTIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-437-6670
Mailing Address - Street 1:16420 HEALTHPARK COMMONS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9621
Mailing Address - Country:US
Mailing Address - Phone:239-437-6670
Mailing Address - Fax:239-437-8871
Practice Address - Street 1:16420 HEALTHPARK COMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-437-6670
Practice Address - Fax:239-437-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76783207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6624Medicare PIN