MEDICARE: ALLEGIANT CONNECTION LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1437825999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANT CONNECTION LLC

Provider Business Mailing Address
First Line	:	7575 N TEUTONIA AVE STE 1
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2041
Country	:	US
Telephone Number	:	262-297-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 N TEUTONIA AVE STE 1
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2041
Country	:	US
Telephone Number	:	262-297-7730
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LAUREN JONES
Credential	:
Telephone Number	:	414-399-1258

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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Directions to “ALLEGIANT CONNECTION LLC ” Practice Location

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