Provider Demographics
NPI:1659455467
Name:DOWNRIVER ASTHMA & ALLERGY CENTER P.C.
Entity Type:Organization
Organization Name:DOWNRIVER ASTHMA & ALLERGY CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SASSACK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:734-283-4600
Mailing Address - Street 1:12811 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1109
Mailing Address - Country:US
Mailing Address - Phone:734-283-4600
Mailing Address - Fax:
Practice Address - Street 1:12811 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1109
Practice Address - Country:US
Practice Address - Phone:734-283-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3168875Medicaid
MI3168875Medicaid
MIA02738Medicare UPIN