Organization
ALLERGY, ASTHMA AND IMMUNOLOGY CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY D CECKO (OFFICE MANAGER)
(651) 765-9800
Entity
Organization
Contact information
Practice address
4625 CHURCHILL ST, SUITE 211, SHOREVIEW, MN 55126-5868
(651) 765-9800
(651) 765-9801
Mailing address
4625 CHURCHILL ST, SUITE 211, SHOREVIEW, MN 55126-5868
(651) 765-9800
(651) 765-9801
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37517500
—
MN
01
—
DB3323
MEDICARE RAILROAD
—
Enumeration date
07/10/2006
Last updated
11/27/2007
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