Provider Demographics
NPI:1831177757
Name:KWILMAN, ALLEN C (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:C
Last Name:KWILMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7967
Mailing Address - Fax:
Practice Address - Street 1:EACH
Practice Address - Street 2:1650 COCHRANE CIRCLE
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32775207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01327758Medicaid
COF04367Medicare UPIN
COE50021Medicare ID - Type Unspecified