Provider Demographics
NPI:1477683936
Name:ALLEN, JOSHUA DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:300 HIGH POINT CT
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6560
Practice Address - Country:US
Practice Address - Phone:502-955-6129
Practice Address - Fax:502-955-8161
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100008650Medicaid
KY000023028VOtherHUMANA
KY5175998OtherCIGNA
KY000000547306OtherANTHEM - ICC
KY50016304OtherPASSPORT
KYP00629110OtherMEDICARE RR - KY
KY2863249000OtherPASSPORT ADVANTAGE
KY000000529716OtherANTHEM
KY089968OtherSIHO
KY0998881Medicare PIN