Provider Demographics
NPI:1982842605
Name:ALLERGY ASTHMA AND IMMUNOLOGY CONSULTANTS INC
Entity Type:Organization
Organization Name:ALLERGY ASTHMA AND IMMUNOLOGY CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHUKAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:PUNJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-2485
Mailing Address - Street 1:1173 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4218
Mailing Address - Country:US
Mailing Address - Phone:352-331-2485
Mailing Address - Fax:352-331-0047
Practice Address - Street 1:1173 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4218
Practice Address - Country:US
Practice Address - Phone:352-331-2485
Practice Address - Fax:352-331-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0055179261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty