Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 4301056577 | MI |
NPI | 1073540647 |
---|---|
Provider Name | Dr. Robert M Allen |
First Address | Saint Joseph, MI 49085-0708 |
Second Address | Saint Joseph, MI 49085-2112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 03/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-31477 | PHP (01) | MI |
1101100942 | BLUE CROSS PIN (01) | MI |
110128164 | RAILROAD MEDICARE (01) | |
1538397120 | GROUP NPI (01) | MI |
270381199 | GROUP TAX ID (01) | MI |
43882593- | (05) | MI |
4876196 | CIGNA (01) | |
BA5056723 | DEA (01) | |
E77394 | (02) |