Basic Information
| Provider Information | |||||||||
| NPI: | 1093720740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASTHMA, ALLERGY AND SINUS CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1108 | ||||||||
| Address2: | ATTN: LYNDA THOMPSON | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481061108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346777400 | ||||||||
| FaxNumber: | 7346777407 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 N DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484711008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106484544 | ||||||||
| FaxNumber: | 8106485924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ABDELJABER | ||||||||
| AuthorizedOfficialFirstName: | MUTEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8106484544 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
ID Information
| ID | Type | State | Issuer | Description | CJ8012 | 01 | MI | RR MEDICARE | OTHER |