Provider Demographics
NPI:1801853742
Name:ALLEN, DEBORAH IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:IRENE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 AMERICAN SQ
Practice Address - Street 2:SUITE 185
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46282-0020
Practice Address - Country:US
Practice Address - Phone:317-278-6161
Practice Address - Fax:317-638-0678
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01026988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100260100Medicaid
IN068010009Medicare PIN