Provider Demographics
NPI:1417016734
Name:ALLERGY & ASTHMA CLINIC OF WYOMING, LLC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CLINIC OF WYOMING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKHMAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-778-2015
Mailing Address - Street 1:6252 YELLOWSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3432
Mailing Address - Country:US
Mailing Address - Phone:307-778-2015
Mailing Address - Fax:307-778-7060
Practice Address - Street 1:6252 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3432
Practice Address - Country:US
Practice Address - Phone:307-778-2015
Practice Address - Fax:307-778-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4234A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty