Provider Demographics
NPI:1831862895
Name:ALLEGIANCE MEDICAL, INC.
Entity type:Organization
Organization Name:ALLEGIANCE MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMSC, PA-C
Authorized Official - Phone:844-726-3926
Mailing Address - Street 1:925 GENESEE ST # 180620
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-9998
Mailing Address - Country:US
Mailing Address - Phone:844-726-3926
Mailing Address - Fax:844-726-3926
Practice Address - Street 1:888 THACKERAY TRL STE 103
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:844-726-3926
Practice Address - Fax:844-726-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty