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OTIS ALLEN MD SC NPI 1457629842


NPI Information

NPI: 1457629842
Provider Name: OTIS ALLEN MD SC
Classification: Plastic Surgery - 208200000X
Entity Type: Organization
Address:
1215 HOLIDAY DR
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 827-3881
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OTIS ALLEN MD SC is a plastic surgery in Bloomington, IL. The provider is a plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. OTIS ALLEN MD SC NPI is 1457629842. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1215 HOLIDAY DR
BLOOMINGTON, IL
ZIP 61704-214
Phone: (309) 827-3881
Fax: (309) 661-0234

The provider's authorized official is Margaret A. Allen .
The authorized official title is Office Manager and has the following contact phone number (309) 827-3881.

The enumeration date for this NPI number is 12/13/2011 and was last updated on 12/13/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208200000XPlastic Surgery036064804ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1691890MEDICARE PINILLINOIS
2036064804MEDICAIDILLINOIS
3D14977MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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