Provider Demographics
NPI:1154341618
Name:ADULT AND CHILD ALLERGY, P.A.
Entity type:Organization
Organization Name:ADULT AND CHILD ALLERGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-645-8182
Mailing Address - Street 1:1690 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3723
Mailing Address - Country:US
Mailing Address - Phone:651-645-8182
Mailing Address - Fax:651-649-3509
Practice Address - Street 1:1690 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 450
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3723
Practice Address - Country:US
Practice Address - Phone:651-645-8182
Practice Address - Fax:651-649-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN342207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00269Medicare ID - Type UnspecifiedGROUP NUMBER