Healthcare Provider Details

I. General information

NPI: 1700822152
Provider Name (Legal Business Name): KATHLEEN G. ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINELLAS ST SUITE 200
CLEARWATER FL
33756-3312
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-2131
  • Fax: 727-462-2115
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME102539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: