Provider Demographics
NPI:1508187360
Name:ALLEN, MICHAEL STEVEN (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 PASO DE MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1130
Mailing Address - Country:US
Mailing Address - Phone:702-292-0531
Mailing Address - Fax:702-877-8770
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4922
Practice Address - Country:US
Practice Address - Phone:907-459-3500
Practice Address - Fax:907-459-3526
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0755207Q00000X
AK7829207Q00000X
NVDO1759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1585553Medicaid
AKK166157Medicare PIN
AK1585553Medicaid