ANDRE LASHAWN ALLEN CEO NPI 1528713013

NPI Information

NPI: 1528713013
Provider Name: ANDRE LASHAWN ALLEN, CEO
Classification: Clinic/Center - 261QM1300X
Entity Type: Individual

Specialization: Multi-Specialty

Address:
20280 GOVERNORS HWY STE 206
OLYMPIA FIELDS, IL
ZIP 60461
Phone: (708) 898-0635
Get Directions

Andre Lashawn Allen, CEO is a multi-specialty clinic center in Olympia Fields, IL. Andre Lashawn Allen, CEO NPI is 1528713013. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

20280 GOVERNORS HWY STE 206
OLYMPIA FIELDS, IL
ZIP 60461-068
Phone: (708) 898-0635

The enumeration date for this NPI number is 2/14/2022 and was last updated on 2/14/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3129197649	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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