Provider Demographics
NPI:1689936890
Name:ALLISON-BJOERLOEW, NATALIA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:ALLISON-BJOERLOEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:NIKOLAEVNA
Other - Last Name:ALLISON, RAKOVA, BULYSHEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7916 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4140
Mailing Address - Country:US
Mailing Address - Phone:260-434-6377
Mailing Address - Fax:260-434-6389
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-6834
Practice Address - Fax:260-435-7394
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101271172207Q00000X
NY308673207Q00000X
RIMD17390207Q00000X
FLTPME963207Q00000X
MEMD23295207Q00000X
KY55172207Q00000X
MA292594207Q00000X
MDD91439207Q00000X
IN01074376A207Q00000X
NH20194207Q00000X
NC2021-00484207Q00000X
OH35.138237207Q00000X
CT64552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3121176Medicaid
IN201088270Medicaid