Provider Demographics
NPI:1679097232
Name:KANTER, ALLISON MACALLISTER (PA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MACALLISTER
Last Name:KANTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:GAYLE
Other - Last Name:MACALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9011 N MERIDIAN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5365
Mailing Address - Country:US
Mailing Address - Phone:317-574-4747
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:8205 E 56TH ST STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1097
Practice Address - Country:US
Practice Address - Phone:317-353-8985
Practice Address - Fax:317-353-2389
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IN10002309A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300025356Medicaid