Organization
DEARBORN ALLERGY & ASTHMA CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY SHORT (OFFICE MANAGER)
(313) 565-3565
Entity
Organization
Contact information
Practice address
20200 OUTER DR, DEARBORN, MI 48124-2634
(313) 565-3565
(313) 565-7723
Mailing address
20200 OUTER DR, DEARBORN, MI 48124-2634
(313) 565-3565
(313) 565-7723
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26340
BLUE CROSS
MI
05
—
1083483
—
MI
05
—
1290003
—
MI
05
—
2838806
—
MI
Enumeration date
08/18/2005
Last updated
04/24/2012
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