Provider Demographics
NPI:1396978086
Name:ALLEN B. DUNNING MD PC
Entity type:Organization
Organization Name:ALLEN B. DUNNING MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-253-1300
Mailing Address - Street 1:309 W 12TH AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-2885
Mailing Address - Country:US
Mailing Address - Phone:906-253-1300
Mailing Address - Fax:
Practice Address - Street 1:309 W 12TH AVE
Practice Address - Street 2:STE 102
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2885
Practice Address - Country:US
Practice Address - Phone:906-253-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4620416Medicaid
MI4620416Medicaid