Provider Demographics
NPI:1972862159
Name:ALLEN, MICHAEL (CPO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5848
Mailing Address - Country:US
Mailing Address - Phone:432-683-3788
Mailing Address - Fax:432-683-6470
Practice Address - Street 1:2502 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5848
Practice Address - Country:US
Practice Address - Phone:432-683-3788
Practice Address - Fax:432-683-6470
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70OtherTEXAS BOARD OF ORTHOTICS AND PROSTHETICS