Provider Demographics
NPI:1417238494
Name:SACKIN, ALLISON LEIGH (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LEIGH
Last Name:SACKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1360
Mailing Address - Country:US
Mailing Address - Phone:785-505-6100
Mailing Address - Fax:785-505-2874
Practice Address - Street 1:325 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1360
Practice Address - Country:US
Practice Address - Phone:785-505-6100
Practice Address - Fax:785-505-2874
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60405736207R00000X
KS05-39575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-39575OtherKANSAS STATE BOARD OF HEALING ARTS
WV2664OtherWEST VIRGINIA BOARD OF OSTEOPATHY
WAOP60405736OtherWASHINGTON STATE MEDICAL LICENSE