Provider Demographics
NPI:1669550653
Name:ALLERGY & ASTHMA CENTER OF NORTHEAST OHIO
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF NORTHEAST OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-762-7475
Mailing Address - Street 1:215 W BOWERY ST
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1069
Mailing Address - Country:US
Mailing Address - Phone:330-762-7475
Mailing Address - Fax:330-253-2412
Practice Address - Street 1:215 W BOWERY ST
Practice Address - Street 2:SUITE 4500
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:330-762-7475
Practice Address - Fax:330-253-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD6471OtherMEDICARE RAILROAD
OH2117097Medicaid
OHDD6471OtherMEDICARE RAILROAD