Healthcare Provider Details

I. General information

NPI: 1073540647
Provider Name (Legal Business Name): ROBERT M ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

PO BOX 708
SAINT JOSEPH MI
49085-0708
US

V. Phone/Fax

Practice location:
  • Phone: 269-471-7741
  • Fax: 269-471-1581
Mailing address:
  • Phone: 269-428-5007
  • Fax: 269-428-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301056577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: