Provider Demographics
NPI:1992797443
Name:HALLQUIST, ALLAN ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:ERNEST
Last Name:HALLQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13351 ROSEHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MORNING VIEW
Mailing Address - State:KY
Mailing Address - Zip Code:41063
Mailing Address - Country:US
Mailing Address - Phone:859-363-3098
Mailing Address - Fax:
Practice Address - Street 1:13351 ROSEHAWK DR
Practice Address - Street 2:
Practice Address - City:MORNING VIEW
Practice Address - State:KY
Practice Address - Zip Code:41063
Practice Address - Country:US
Practice Address - Phone:859-363-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0028646207ZN0500X
KY26846207ZP0102X
OH35059201207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64078876Medicaid
0220304Medicare PIN
E10498Medicare UPIN
KY64078876Medicare ID - Type Unspecified
KY64078876Medicaid