Provider Demographics
NPI:1841454063
Name:ALLERGIC DISEASE AND ASTHMA CENTER
Entity type:Organization
Organization Name:ALLERGIC DISEASE AND ASTHMA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-269-0386
Mailing Address - Street 1:PO BOX 27129
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-2129
Mailing Address - Country:US
Mailing Address - Phone:864-627-3800
Mailing Address - Fax:864-672-2653
Practice Address - Street 1:1202 E BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5910
Practice Address - Country:US
Practice Address - Phone:864-627-3800
Practice Address - Fax:864-672-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225018Medicaid
SC225018Medicaid