Provider Demographics
NPI:1184614760
Name:ALLEN, JAMISON D (DO)
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:D
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2560 HAUSER ROSS DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3150
Mailing Address - Country:US
Mailing Address - Phone:703-964-8199
Mailing Address - Fax:815-478-3070
Practice Address - Street 1:2560 HAUSER ROSS DR
Practice Address - Street 2:SUITE 450
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3150
Practice Address - Country:US
Practice Address - Phone:703-964-8199
Practice Address - Fax:815-478-3070
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2022-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036098973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098973Medicaid
ILG94620Medicare UPIN
ILF400099298Medicare PIN
IL036098973Medicaid
ILK15360Medicare PIN