Basic Information
| Provider Information | |||||||||
| NPI: | 1073540647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 708 | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490850708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694285007 | ||||||||
| FaxNumber: | 2694282789 | ||||||||
| Practice Location | |||||||||
| Address1: | 1234 NAPIER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694717741 | ||||||||
| FaxNumber: | 2694711581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 4301056577 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4876196 | 01 | CIGNA | OTHER | 1101100942 | 01 | MI | BLUE CROSS PIN | OTHER | BA5056723 | 01 | DEA | OTHER | 1538397120 | 01 | MI | GROUP NPI | OTHER | 43882593- | 05 | MI | MEDICAID | 04-31477 | 01 | MI | PHP | OTHER | 270381199 | 01 | MI | GROUP TAX ID | OTHER | 110128164 | 01 | RAILROAD MEDICARE | OTHER |