Provider Demographics
NPI:1528152246
Name:ALLERGY & ASTHMA MANAGEMENT CENTER PC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA MANAGEMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKHARI PANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-478-6300
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1209
Mailing Address - Country:US
Mailing Address - Phone:248-380-9630
Mailing Address - Fax:248-380-3459
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1209
Practice Address - Country:US
Practice Address - Phone:248-380-9630
Practice Address - Fax:248-380-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB069790207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104137425Medicaid
MI030F320750OtherBCBS OF MICHIGAN
MA114121OtherCARE CHOICES
MIC5076OtherMCARE
MA114121OtherCARE CHOICES
MI104137425Medicaid