Provider Demographics
NPI:1417034695
Name:ALLERGY, ASTHMA & SINUS CARE CENTER, LLC
Entity Type:Organization
Organization Name:ALLERGY, ASTHMA & SINUS CARE CENTER, LLC
Other - Org Name:ALLERGY, ASTHMA & FOOD CENTERS OF ST. LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BORTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-849-8700
Mailing Address - Street 1:9701 LANDMARK PARKWAY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1665
Mailing Address - Country:US
Mailing Address - Phone:314-849-8700
Mailing Address - Fax:
Practice Address - Street 1:9701 LANDMARK PARKWAY DR STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1665
Practice Address - Country:US
Practice Address - Phone:314-849-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5G81207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty