Organization
ALLERGY AND ASTHMA CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMACHANDRA K PUDUPAKKAM MD (PRESIDENT)
(419) 227-4602
Entity
Organization
Contact information
Practice address
528 W MARKET ST, SUITE 120, LIMA, OH 45801-4762
(419) 227-4602
(419) 221-1025
Mailing address
528 W MARKET ST, SUITE 120, LIMA, OH 45801-4762
(419) 227-4602
(419) 221-1025
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
35035640
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000514711
ANTHEM BC/BS
—
05
—
2041418
—
OH
Enumeration date
09/06/2007
Last updated
01/04/2012
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