MEDICARE: SUSAN ALLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1497103428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ALLEN

Provider Business Mailing Address
First Line	:	16049 PEACH RIDGE AVE
Second Line	:
City	:	KENT CITY
State	:	MI
Zip	:	49330-9758
Country	:	US
Telephone Number	:	616-835-2608
Fax Number	:

Provider Business Practice Location Address
First Line	:	16049 PEACH RIDGE AVE
Second Line	:
City	:	KENT CITY
State	:	MI
Zip	:	49330-9758
Country	:	US
Telephone Number	:	616-835-2608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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Directions to “ SUSAN ALLEN ” Practice Location

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