Provider Demographics
NPI:1730378738
Name:ALLERGY ASSOCIATES OF DEARBORN
Entity type:Organization
Organization Name:ALLERGY ASSOCIATES OF DEARBORN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-274-3311
Mailing Address - Street 1:751 S MILITARY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2107
Mailing Address - Country:US
Mailing Address - Phone:313-274-3311
Mailing Address - Fax:313-274-3587
Practice Address - Street 1:751 S MILITARY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2107
Practice Address - Country:US
Practice Address - Phone:313-274-3311
Practice Address - Fax:313-274-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB047245207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02507830130OtherAMA
MI030001206OtherRAILROAD MEDICARE
MI0822360OtherBCBS OF MI
MIE49608Medicare UPIN
MI0P12190Medicare PIN