Provider Demographics
NPI:1649202128
Name:ALLERGY & ASTHMA CLINIC OF KENOSHA SC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CLINIC OF KENOSHA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KULWANT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-657-9390
Mailing Address - Street 1:4906 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2108
Mailing Address - Country:US
Mailing Address - Phone:262-657-9390
Mailing Address - Fax:262-657-4666
Practice Address - Street 1:4906 39TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2108
Practice Address - Country:US
Practice Address - Phone:262-657-9390
Practice Address - Fax:262-657-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32656900Medicaid
WI32656900Medicaid