MEDICARE: DR. KERRY MICHAEL 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	207W00000X	Ophthalmology Physician	35051610-A	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184605990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY MICHAEL ALLEN M.D.

Provider Business Mailing Address
First Line	:	278 BENEDICT AVE
Second Line	:	STE. 300 MEDICAL PARK III
City	:	NORWALK
State	:	OH
Zip	:	44857-2399
Country	:	US
Telephone Number	:	419-668-3295
Fax Number	:	419-668-8861

Provider Business Practice Location Address
First Line	:	278 BENEDICT AVE
Second Line	:	STE. 300 MEDICAL PARK III
City	:	NORWALK
State	:	OH
Zip	:	44857-2399
Country	:	US
Telephone Number	:	419-668-3295
Fax Number	:	419-668-8861

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	01/16/2008

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