MEDICARE: GEORGE 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	172A00000X	Driver

General Provider Information

NPI Number	:	1609290071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE ALLEN

Provider Business Mailing Address
First Line	:	PO BOX 68081
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-0081
Country	:	US
Telephone Number	:	317-313-5008
Fax Number	:

Provider Business Practice Location Address
First Line	:	9580 MAPLE WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3279
Country	:	US
Telephone Number	:	317-313-5008
Fax Number	:

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	02/05/2014

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Directions to “ GEORGE ALLEN ” Practice Location

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