Provider Demographics
NPI:1770036691
Name:CENTERS FOR ALLERGY, ASTHMA AND IMMUNE DISORDERS PC
Entity Type:Organization
Organization Name:CENTERS FOR ALLERGY, ASTHMA AND IMMUNE DISORDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO MIR
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-570-0595
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-574-6830
Mailing Address - Fax:515-574-6097
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6830
Practice Address - Fax:515-574-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29873207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3179507Medicaid
IA13395Medicare PIN
IA3179507Medicaid