Provider Demographics
NPI:1144242363
Name:ALLEN, HERBERT MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MARTIN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 N BALLARD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8988
Mailing Address - Country:US
Mailing Address - Phone:920-202-3954
Mailing Address - Fax:920-202-3964
Practice Address - Street 1:3301 N BALLARD RD
Practice Address - Street 2:SUITE C
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8988
Practice Address - Country:US
Practice Address - Phone:920-202-3954
Practice Address - Fax:920-202-3964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30176500Medicaid
B51146Medicare UPIN
WI30176500Medicaid