Provider Demographics
NPI:1942402284
Name:ALLAN, KATHERINE FEDERLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FEDERLINE
Last Name:ALLAN
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 1:500 S GREER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3212
Mailing Address - Country:US
Mailing Address - Phone:901-219-9252
Mailing Address - Fax:
Practice Address - Street 1:100 N HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2146
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-322-2994
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165578001Medicaid
TN3000460Medicaid
MS03170013Medicaid
MO208332106Medicaid
TN9813049OtherAETNA
AR84616OtherBCBS AR
TN4159066OtherBCBS TN
AR165578001Medicaid
MS03170013Medicaid