Basic Information
| Provider Information | |||||||||
| NPI: | 1366461402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLISON | ||||||||
| FirstName: | BENNIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1500 | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483761500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483240700 | ||||||||
| FaxNumber: | 2483241477 | ||||||||
| Practice Location | |||||||||
| Address1: | 7330 SOUTHERN BLVD | ||||||||
| Address2: | UNIT 6 | ||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445125620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307263379 | ||||||||
| FaxNumber: | 3307268683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 35048953 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.