Provider Demographics
NPI:1568646420
Name:ALLERGY ASTHMA AND IMMUNOLOGY
Entity Type:Organization
Organization Name:ALLERGY ASTHMA AND IMMUNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-277-3114
Mailing Address - Street 1:1019 MAJESTIC DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1947
Mailing Address - Country:US
Mailing Address - Phone:859-277-3114
Mailing Address - Fax:
Practice Address - Street 1:40 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9750
Practice Address - Country:US
Practice Address - Phone:859-277-3114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6928Medicare PIN