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NPI Code Detail

MEDICARE: ANTHONY JEROME ALLEN AAS., CAC II

MEDICARE: ANTHONY JEROME ALLEN AAS., CAC II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor820202MI

General Provider Information

NPI Number : 1003023680
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY JEROME ALLEN AAS., CAC II
Provider Business Mailing Address
First Line : 5113 BANGOR ST
Second Line :
City : DETROIT
State : MI
Zip : 48210-1760
Country : US
Telephone Number : 313-867-1090
Fax Number : 313-867-0706
Provider Business Practice Location Address
First Line : 12010 LINWOOD ST
Second Line :
City : DETROIT
State : MI
Zip : 48206-1108
Country : US
Telephone Number : 313-867-1090
Fax Number : 313-867-0706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 07/08/2007

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