Provider Demographics
NPI:1801901780
Name:ALLEN, KEVIN P (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9013
Mailing Address - Country:US
Mailing Address - Phone:316-283-0113
Mailing Address - Fax:316-283-6401
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9013
Practice Address - Country:US
Practice Address - Phone:316-283-0113
Practice Address - Fax:316-283-6401
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200300114207W00000X
KS04-33342207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200590310CMedicaid
KS1801901780OtherMEDICARE
KS1801901780OtherMEDICARE