Provider Demographics
NPI:1902948151
Name:U P ASTHMA AND ALLERGY CENTER
Entity Type:Organization
Organization Name:U P ASTHMA AND ALLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-4725
Mailing Address - Street 1:1414 W FAIR AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5406
Mailing Address - Country:US
Mailing Address - Phone:906-225-4725
Mailing Address - Fax:
Practice Address - Street 1:1414 W FAIR AVE STE 216
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5406
Practice Address - Country:US
Practice Address - Phone:906-225-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050543207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI030520091OtherBLUE CROSS BLUE SHIELD MI
MI102843109Medicaid
MI030520091OtherBLUE CROSS BLUE SHIELD MI
MIF26386Medicare UPIN
MI0P48410Medicare PIN
MI0520091Medicare PIN