Provider Demographics
NPI:1558587881
Name:ALLEN, MICHAEL EDMUND
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDMUND
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 5TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1907
Mailing Address - Country:US
Mailing Address - Phone:304-523-4076
Mailing Address - Fax:304-523-8900
Practice Address - Street 1:501 5TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1907
Practice Address - Country:US
Practice Address - Phone:304-523-4076
Practice Address - Fax:304-523-8900
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2471N0900X2471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology