MEDICARE: MR. RONALD L ALLEN MD

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	207W00000X	Ophthalmology Physician	26907-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1014080001	OTHER	WI	ADMINASTAR-DMERC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518967470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD L ALLEN MD

Provider Business Mailing Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-752-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-752-2020
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	02/24/2009

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