Provider Demographics
NPI:1770591349
Name:ADVANCED ALLERGY CARE
Entity type:Organization
Organization Name:ADVANCED ALLERGY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALLIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-441-9944
Mailing Address - Street 1:PO BOX 8877
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8877
Mailing Address - Country:US
Mailing Address - Phone:936-441-9944
Mailing Address - Fax:936-441-9910
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:#120
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2888
Practice Address - Country:US
Practice Address - Phone:936-441-9944
Practice Address - Fax:936-441-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0838207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058EVOtherBCBS
TXDC1025OtherRAILROAD MEDICARE
TX175506801Medicaid
TXDC1025OtherRAILROAD MEDICARE
TX175506801Medicaid