Provider Demographics
NPI:1720007271
Name:ALLEN, TIMOTHY WILLIAM (MD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4580 S NICHOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1360
Mailing Address - Country:US
Mailing Address - Phone:414-326-4800
Mailing Address - Fax:855-270-4751
Practice Address - Street 1:4580 S NICHOLSON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1360
Practice Address - Country:US
Practice Address - Phone:414-326-4800
Practice Address - Fax:855-270-4751
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45304-020207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02120-0167Medicare PIN
WI68015-0074Medicare PIN
WI02120-0167Medicare PIN