NPIMap

Organization Active NPI

Plymouth Asthma & Allergy Center PC

  • Allergy & Immunology Physician
  • Plymouth, MI
National Provider Identifier
1306808407
Registry record updated May 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
5101004511 Issued in MI
Legal business name
PLYMOUTH ASTHMA & ALLERGY CENTER PC
Practice address
9398 N Lilley Rd
Plymouth, MI 48170-4610
Phone
(734) 459-2255
Fax
(734) 459-1855
NPI assigned
Apr 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack W Pearl, DO
Title
President
Phone
(734) 459-2255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X 5101004511 MI Primary

Addresses

Primary practice location

9398 N Lilley Rd
Plymouth, MI 48170-4610

Mailing address

9398 N Lilley Rd
Plymouth, MI 48170-4610
Phone (734) 459-2255

Other identifiers 1

IdentifierTypeStateIssuer
2628611MedicaidMI

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1306808407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9398 N LILLEY RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704610",
            "telephone_number": "734-459-2255",
            "fax_number": "734-459-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9398 N LILLEY RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704610",
            "telephone_number": "734-459-2255",
            "fax_number": "734-459-1855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH ASTHMA & ALLERGY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "PEARL",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-459-2255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "MI",
            "license": "5101004511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2628611",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.