Healthcare Provider Details

I. General information

NPI: 1851075568
Provider Name (Legal Business Name): MITCHEL M ALLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 S BAILEY AVE STE 200
SOUTH HAVEN MI
49090-6743
US

IV. Provider business mailing address

601 JOHN ST # 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-639-2772
  • Fax: 269-639-2767
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301518150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: