Provider Demographics
NPI:1508874983
Name:ALLABEN, DAVID G (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:ALLABEN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 - PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N CAPITOL AVE
Practice Address - Street 2:NP E-140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1218
Practice Address - Country:US
Practice Address - Phone:317-962-2894
Practice Address - Fax:317-963-5285
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-01-26
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Provider Licenses
StateLicense IDTaxonomies
IN10000634A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01216656Medicare PIN
IN165460FFFFMedicare PIN
INQ01060Medicare UPIN
INM400017912Medicare PIN