Provider Demographics
NPI:1487609616
Name:ALLISON, ARDIS K (DO)
Entity type:Individual
Prefix:
First Name:ARDIS
Middle Name:K
Last Name:ALLISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5551 WINGHAVEN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3617
Mailing Address - Country:US
Mailing Address - Phone:636-561-5561
Mailing Address - Fax:636-561-5557
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3605
Practice Address - Country:US
Practice Address - Phone:636-561-5561
Practice Address - Fax:636-561-5557
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3J00208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF50153Medicare UPIN