Provider Demographics
NPI:1619197381
Name:ALLERGY AND ASTHMATIC DISEASE A MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMATIC DISEASE A MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-568-3595
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:WRIGHT BLDG #100
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-568-3595
Mailing Address - Fax:760-779-8671
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:WRIGHT BLDG #100
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-568-3595
Practice Address - Fax:760-779-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78476ZMedicare ID - Type Unspecified
CAA43186Medicare UPIN