Provider Demographics
NPI:1043235153
Name:ALLEN, NIKKI (MD)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4580 S NICHOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1360
Mailing Address - Country:US
Mailing Address - Phone:414-326-4800
Mailing Address - Fax:855-720-4751
Practice Address - Street 1:4580 S NICHOLSON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1360
Practice Address - Country:US
Practice Address - Phone:414-326-4800
Practice Address - Fax:855-270-4751
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43605-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0099Medicare PIN
WI02120-0302Medicare PIN