Individual
DR. OTIS GEORGE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 HOLIDAY DR, BLOOMINGTON, IL 61704-2214
(309) 827-3881
(309) 661-0234
Mailing address
53 PRENZLER DR, BLOOMINGTON, IL 61704-1299
(309) 287-8049
(309) 661-0234
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036064804
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036064804
—
IL
Enumeration date
08/03/2005
Last updated
08/17/2016
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