MEDICARE: DR. MARK J. ALLEN M.D.

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
1	2085R0202X	Diagnostic Radiology Physician	79952	MN
2	2085R0202X	Diagnostic Radiology Physician	13698-320	WI
3	2085R0202X	Diagnostic Radiology Physician	22566	ND

General Provider Information

NPI Number	:	1134355662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. ALLEN M.D.

Provider Business Mailing Address
First Line	:	2355 HIGHWAY 36 W STE 100
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3905
Country	:	US
Telephone Number	:	651-292-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 HWY 36 W
Second Line	:	STE. 100
City	:	ROSEVILLE
State	:	MN
Zip	:	55113
Country	:	US
Telephone Number	:	651-292-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/26/2026

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