# KEVIN L VANALLEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154373249
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301053221 | MI | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 02/16/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0804103371 | BCBS | MI |
| 01 | — | 1598712390 | GROUP NPI | MI |
| 05 | — | 4770001 | — | MI |
| 05 | — | 4770010 | — | MI |
| 05 | — | 4770020 | — | MI |
| 05 | — | 4773881 | — | MI |
| 05 | — | 4773952 | — | MI |