Provider Demographics
NPI:1609898287
Name:ALLERGIC DISEASES SC
Entity Type:Organization
Organization Name:ALLERGIC DISEASES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-545-1111
Mailing Address - Street 1:11121 WEST OKLAHOMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227
Mailing Address - Country:US
Mailing Address - Phone:414-545-1111
Mailing Address - Fax:414-545-1144
Practice Address - Street 1:11121 WEST OKLAHOMA AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-545-1111
Practice Address - Fax:414-545-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32694400Medicaid
WI32694400Medicaid