Basic Information
| Provider Information | |||||||||
| NPI: | 1477683936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HIGH POINT CT | ||||||||
| Address2: | |||||||||
| City: | MT WASHINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400476560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029556129 | ||||||||
| FaxNumber: | 5029558161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 40677 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000547306 | 01 | KY | ANTHEM - ICC | OTHER | 000023028V | 01 | KY | HUMANA | OTHER | 50016304 | 01 | KY | PASSPORT | OTHER | 000000529716 | 01 | KY | ANTHEM | OTHER | 2863249000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 5175998 | 01 | KY | CIGNA | OTHER | P00629110 | 01 | KY | MEDICARE RR - KY | OTHER | 089968 | 01 | KY | SIHO | OTHER | 7100008650 | 05 | KY | MEDICAID |