Provider Demographics
NPI:1134506645
Name:ALLEGIANT COMPREHENSIVE CARE, LLC
Entity Type:Organization
Organization Name:ALLEGIANT COMPREHENSIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:NDI
Authorized Official - Last Name:NUKUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:267-650-7880
Mailing Address - Street 1:700 W LEA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2500
Mailing Address - Country:US
Mailing Address - Phone:302-384-7639
Mailing Address - Fax:
Practice Address - Street 1:700 W LEA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2500
Practice Address - Country:US
Practice Address - Phone:302-384-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0078430207V00000X
DEC1-0009130207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty