Provider Demographics
NPI:1265440390
Name:ALLERGY ASTHMA CARE P.C.
Entity type:Organization
Organization Name:ALLERGY ASTHMA CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-531-5855
Mailing Address - Street 1:2802 LEONARD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7136
Mailing Address - Country:US
Mailing Address - Phone:219-531-5855
Mailing Address - Fax:219-531-1617
Practice Address - Street 1:2802 LEONARD DR STE 100
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7136
Practice Address - Country:US
Practice Address - Phone:219-531-5855
Practice Address - Fax:219-531-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049183A174400000X
IN02000639A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200418460Medicaid
IN205770Medicare ID - Type Unspecified
IN200418460Medicaid
INE35229Medicare UPIN