Provider Demographics
NPI:1811041064
Name:ADVANCED ALLERGY ASTHMA&IMMUNOLOGY
Entity Type:Organization
Organization Name:ADVANCED ALLERGY ASTHMA&IMMUNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-746-3336
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-0127
Mailing Address - Country:US
Mailing Address - Phone:352-746-3336
Mailing Address - Fax:352-746-3305
Practice Address - Street 1:508 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8547
Practice Address - Country:US
Practice Address - Phone:352-746-3336
Practice Address - Fax:352-746-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86742207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266381301Medicaid
FL266381301Medicaid