Provider Demographics
NPI:1780683581
Name:ALLAN, KENNETH J (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:ALLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7350 E PROGRESS PL
Mailing Address - Street 2:STE 201
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2135
Mailing Address - Country:US
Mailing Address - Phone:720-282-4707
Mailing Address - Fax:303-539-7467
Practice Address - Street 1:7350 E PROGRESS PL
Practice Address - Street 2:STE 201
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2135
Practice Address - Country:US
Practice Address - Phone:720-282-4707
Practice Address - Fax:303-539-4767
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO38390207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF60957Medicare UPIN
CO809247Medicare PIN
IN083890Medicare ID - Type Unspecified
F60957Medicare UPIN
IL036080256Medicaid