Provider Demographics
NPI:1871536730
Name:ALLEN, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-705-5605
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1300 DRESDEN DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2476
Practice Address - Country:US
Practice Address - Phone:815-942-5200
Practice Address - Fax:815-942-5330
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036078159208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0003200054OtherBLUE CROSS BLUE SHIELD
IL020442OtherHEALTH ALLIANCE
IL020019476OtherRAIL ROAD MEDICARE
IL036078159Medicaid
IL036078159Medicaid
IL0003200054OtherBLUE CROSS BLUE SHIELD