Provider Demographics
NPI:1588743645
Name:WARREN ALLERGY & ASTHMA CARE PC
Entity type:Organization
Organization Name:WARREN ALLERGY & ASTHMA CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRASNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-268-9222
Mailing Address - Street 1:31730 HOOVER RD
Mailing Address - Street 2:SUITEA
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-1700
Mailing Address - Country:US
Mailing Address - Phone:586-268-9222
Mailing Address - Fax:586-268-9226
Practice Address - Street 1:37130 HOOVER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-268-9222
Practice Address - Fax:586-268-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG39644OtherHAP
MI030E021890OtherBCN GROUP
MI1588743645Medicaid
MI030E021890OtherBCBS GROUP
MIDQ3348OtherRAILROAD MEDICARE
MIDQ3348OtherRAILROAD MEDICARE
MIG39644Medicare UPIN