Provider Demographics
NPI:1225174519
Name:ALLERGY ASTHMA & IMMUNOLOGY SPECIALISTS PC
Entity Type:Organization
Organization Name:ALLERGY ASTHMA & IMMUNOLOGY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KRESHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-647-1200
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-647-1200
Mailing Address - Fax:248-647-1329
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 215
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-647-1200
Practice Address - Fax:248-647-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK046958207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2735649Medicaid
MI2735649Medicaid