Provider Demographics
NPI:1104032176
Name:ANDERSON ALLERGY AND ASTHMA, PA
Entity type:Organization
Organization Name:ANDERSON ALLERGY AND ASTHMA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-872-1110
Mailing Address - Street 1:63 W UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1118
Mailing Address - Country:US
Mailing Address - Phone:407-872-1110
Mailing Address - Fax:407-839-4869
Practice Address - Street 1:63 W UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1118
Practice Address - Country:US
Practice Address - Phone:407-872-1110
Practice Address - Fax:407-839-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46655174400000X
FLME 7956174400000X
FLPA9100990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48442ZMedicare ID - Type Unspecified
FLD55287Medicare UPIN
FL59971ZMedicare ID - Type Unspecified
FLD65222Medicare UPIN