Provider Demographics
NPI:1699755207
Name:ALLEN, TEMPEST A (MD)
Entity type:Individual
Prefix:
First Name:TEMPEST
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4666
Mailing Address - Country:US
Mailing Address - Phone:269-327-2211
Mailing Address - Fax:269-327-0273
Practice Address - Street 1:3300 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4666
Practice Address - Country:US
Practice Address - Phone:269-327-2211
Practice Address - Fax:269-327-0273
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4432603Medicaid
MI1699755207Medicaid
MI4218238Medicaid
MICB9054OtherRAILROAD MEDICARE
MI1235131137OtherBCBSM - BLH
MI1235131137OtherBCBSM - BLH
MI1699755207Medicaid
MICB9054OtherRAILROAD MEDICARE
MI4218238Medicaid