Basic Information
| Provider Information | |||||||||
| NPI: | 1508018128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDLIN | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N OSAGE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640502705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163562000 | ||||||||
| FaxNumber: | 8167371796 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N OSAGE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640502705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163562000 | ||||||||
| FaxNumber: | 8167371796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301093159 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2014039905 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.