Healthcare Provider Details

I. General information

NPI: 1073407433
Provider Name (Legal Business Name): ALLEN FAMILY MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 S NICHOLSON AVE
CUDAHY WI
53110-1360
US

IV. Provider business mailing address

4580 S NICHOLSON AVE
CUDAHY WI
53110-1360
US

V. Phone/Fax

Practice location:
  • Phone: 414-326-4800
  • Fax: 855-270-4751
Mailing address:
  • Phone: 414-326-4800
  • Fax: 855-270-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY WILLIAM ALLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 414-326-4800