Provider Demographics
NPI:1710963889
Name:ALLEN, ALECIA P (MD)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:P
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S BLAIRSFERRY XING
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-7988
Mailing Address - Country:US
Mailing Address - Phone:319-393-0783
Mailing Address - Fax:319-393-0427
Practice Address - Street 1:400 S BLAIRSFERRY XING
Practice Address - Street 2:SUITE A
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-7988
Practice Address - Country:US
Practice Address - Phone:319-393-0783
Practice Address - Fax:319-393-0427
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA35227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1271296Medicaid
IA3271296Medicaid
IAP00368630OtherRR MEDICARE
IA2271296Medicaid
IA1710963889Medicaid
IAI00134Medicare UPIN
IA1710963889Medicaid
IAI15519Medicare PIN