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General NPI Number Information
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NPI Number | 1073407433
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Entity Type | Organization
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Legal Business Name | ALLEN FAMILY MEDICINE SC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 4580 S NICHOLSON AVE
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City | CUDAHY
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State | WI
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Zip | 53110-1360
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Country | US
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Telephone | 414-326-4800
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Fax | 855-270-4751
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Provider Business Mailing Address
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Address Line | 4580 S NICHOLSON AVE
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City | CUDAHY
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State | WI
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Zip | 53110-1360
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Country | US
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Telephone | 414-326-4800
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Fax | 855-270-4751
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY WILLIAM ALLEN
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Credential | MD
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Telephone | 414-326-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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