Provider Demographics
NPI:1598807737
Name:ALLERGY & ASTHMA ASSOCIATES
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-3936
Mailing Address - Street 1:1414 W FAIR AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5404
Mailing Address - Country:US
Mailing Address - Phone:906-225-3936
Mailing Address - Fax:
Practice Address - Street 1:1414 W FAIR AVE STE 108
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5404
Practice Address - Country:US
Practice Address - Phone:906-225-3936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054887207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0305210272OtherBLUE CROSS BLUE SHIELD MI
MI102593507Medicaid
MI0305210272OtherBLUE CROSS BLUE SHIELD MI
MIC61697Medicare UPIN