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Organization

OTIS ALLEN MD SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARGARET A. ALLEN (OFFICE MANAGER)
(309) 827-3881
Entity
Organization

Contact information

Practice address
1215 HOLIDAY DR, BLOOMINGTON, IL 61704-2214
(309) 827-3881
(309) 661-0234
Mailing address
1215 HOLIDAY DR, BLOOMINGTON, IL 61704-2214
(309) 827-3881
(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
12/13/2011
Last updated
12/13/2011
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