Provider Demographics
NPI:1447061510
Name:ALLEN, SAMUEL KENNETH
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KENNETH
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4683 AUSTIN TRCE
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9666
Mailing Address - Country:US
Mailing Address - Phone:317-450-9414
Mailing Address - Fax:
Practice Address - Street 1:4683 AUSTIN TRCE
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9666
Practice Address - Country:US
Practice Address - Phone:317-450-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program