Allergy & Asthma Clinic of Kenosha SC
Organization Active NPI Medical Specialty Clinic/Center · Kenosha, WI
NPI 1649202128 · NPPES record last updated Nov 7, 2008
Key facts
- NPI
- 1649202128
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medical Specialty Clinic/Center 261QM2500X
- Legal business name
- ALLERGY & ASTHMA CLINIC OF KENOSHA SC
- Practice address
- 4906 39TH Ave
Kenosha, WI 53144-2108 - Phone
- (262) 657-9390
- Fax
- (262) 657-4666
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Kulwant Singh Dhaliwal, MD
- Title
- President
- Phone
- (262) 657-9390
National Provider Directory
Locations
4906 39th Ave
Kenosha, WI 53144
Phone (262) 657-4666
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | WI | Yes |
Addresses
Primary practice location
4906 39TH Ave
Kenosha, WI 53144-2108
Mailing address
4906 39TH Ave
Kenosha, WI 53144-2108
Phone (262) 657-9390
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32656900 | Medicaid | WI |
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All providers in Kenosha, WI · Medical Specialty Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.