Provider Demographics
NPI:1780653535
Name:ACADEMY ALLERGY ASTHMA & SINUS, PC
Entity Type:Organization
Organization Name:ACADEMY ALLERGY ASTHMA & SINUS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-621-2455
Mailing Address - Street 1:14540 PRAIRIE LAKES BLVD N
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4370
Mailing Address - Country:US
Mailing Address - Phone:317-621-2455
Mailing Address - Fax:317-355-6166
Practice Address - Street 1:14540 PRAIRIE LAKES BLVD N
Practice Address - Street 2:SUITE 207
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060
Practice Address - Country:US
Practice Address - Phone:317-621-2455
Practice Address - Fax:317-355-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004268A207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458990AMedicaid
IN200458990AMedicaid
IN216290Medicare PIN