Provider Demographics
NPI:1518032325
Name:ALLERGY AND ASTHMA ASSOCIATES, SC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-739-5213
Mailing Address - Street 1:436 E LONGVIEW DR STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2166
Mailing Address - Country:US
Mailing Address - Phone:920-739-5213
Mailing Address - Fax:920-739-1444
Practice Address - Street 1:436 - B EAST LONGVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-739-5213
Practice Address - Fax:920-739-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34066021207K00000X
WI2845520207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30066000Medicaid
WI30859900Medicaid
WI30066000Medicaid
000080546Medicare ID - Type UnspecifiedKAREN KONZ
WI30859900Medicaid
G03611Medicare UPIN