Provider Demographics
NPI:1164798906
Name:MARK L ALLEN MD, INC
Entity Type:Organization
Organization Name:MARK L ALLEN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-674-5230
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-674-5230
Mailing Address - Fax:216-674-5231
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-674-5230
Practice Address - Fax:216-674-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18589207L00000X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058842Medicaid
OHH082431OtherMEDICARE PTAN
OHC51026Medicare UPIN