Provider Demographics
NPI:1699792580
Name:ALLERGY ASSOCIATES OF WESTERN MICHIGAN P.C.
Entity type:Organization
Organization Name:ALLERGY ASSOCIATES OF WESTERN MICHIGAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-531-6900
Mailing Address - Street 1:3185 MACATAWA DR SW STE B
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3184
Mailing Address - Country:US
Mailing Address - Phone:616-531-6900
Mailing Address - Fax:616-531-5847
Practice Address - Street 1:3185 MACATAWA DR SW STE B
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3184
Practice Address - Country:US
Practice Address - Phone:616-531-6900
Practice Address - Fax:616-531-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI030D163140OtherBLUE CROSS BLUE SHIELD