Provider Demographics
NPI:1255360418
Name:HOLLAND ALLERGY CLINIC PC
Entity type:Organization
Organization Name:HOLLAND ALLERGY CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ALBERTSON
Authorized Official - Last Name:MUNDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:616-392-2516
Mailing Address - Street 1:844 S WASHINGTON SUITE 500
Mailing Address - Street 2:BLDG 1 SUITE 500
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7146
Mailing Address - Country:US
Mailing Address - Phone:616-392-2516
Mailing Address - Fax:616-392-1418
Practice Address - Street 1:844 S WASHINGTON SUITE 500
Practice Address - Street 2:BLDG 1 SUITE 500
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7146
Practice Address - Country:US
Practice Address - Phone:616-392-2516
Practice Address - Fax:616-392-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056696207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0030255OtherBCBS ID
MI0030255OtherBCN ID
MI1255360418OtherFED BCBS