Provider Demographics
NPI:1780684118
Name:ALLEN, BRIAN KENELM (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENELM
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:31355 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-4280
Mailing Address - Country:US
Mailing Address - Phone:507-643-6558
Mailing Address - Fax:
Practice Address - Street 1:1300 BADGER ST
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-1502
Practice Address - Country:US
Practice Address - Phone:608-785-5104
Practice Address - Fax:608-785-5146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI28854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics