Provider Demographics
NPI:1659361608
Name:ALLEN, J SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:SCOTT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26111 FRANKLIN ROAD
Mailing Address - Street 2:#201C
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-626-7008
Mailing Address - Fax:248-626-7057
Practice Address - Street 1:26111 W 14 MILE RD
Practice Address - Street 2:201C
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1168
Practice Address - Country:US
Practice Address - Phone:248-626-7008
Practice Address - Fax:248-626-7057
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJA0259162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1390591Medicaid
MI1390591Medicaid
MI2606301392Medicare ID - Type Unspecified