Provider Demographics
NPI:1295722445
Name:ALLERGY & ASTHMA SPECIALISTS PC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-828-1232
Mailing Address - Street 1:10, CONWAY SPRINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3411
Mailing Address - Country:US
Mailing Address - Phone:636-928-1232
Mailing Address - Fax:
Practice Address - Street 1:4200 N CLOVERLEAF DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6436
Practice Address - Country:US
Practice Address - Phone:636-928-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34881207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP0200039OtherUNITEDHEALTHCARE
MO26775OtherBLUECROSSBLUESHIELD
MO222470OtherGROUPHEALTHPLAN
MD0004000868OtherAETNA HEALTH INSURANCE
MO0689941002OtherCIGNA HEALTH INSURANCE
ILOOO6000455OtherBLUECROSSBLUESHIELD
MO222470OtherGROUPHEALTHPLAN
MOP0200039OtherUNITEDHEALTHCARE
A09886Medicare UPIN