Provider Demographics
NPI:1487715157
Name:CANTON ASTHMA & ALLERGY PC
Entity type:Organization
Organization Name:CANTON ASTHMA & ALLERGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARZOOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-394-2661
Mailing Address - Street 1:1600 S CANTON CENTER RD STE 360
Mailing Address - Street 2:CANTON ASTHMA & ALLERGY
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-0004
Mailing Address - Country:US
Mailing Address - Phone:734-394-2661
Mailing Address - Fax:734-394-2666
Practice Address - Street 1:1600 S CANTON CENTER RD STE 360
Practice Address - Street 2:CANTON ASTHMA & ALLERGY
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-0004
Practice Address - Country:US
Practice Address - Phone:734-394-2661
Practice Address - Fax:734-394-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID NUMBER
MI=========OtherTAX ID NUMBER