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Contact Information

OTIS G ALLEN, MD
1215 HOLIDAY DR
BLOOMINGTON, IL61704-2214
 Phone: 309-827-3881
 Fax: 309-661-0234
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Plastic Surgery

208200000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for OTIS G ALLEN · (Male)

NPI # 1306847900
Status Active
Credentials MD
Entity Individual
Enumeration date 08/03/2005
Last updated 08/17/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036064804
  • IL Medicaid 036064804
Hospital affiliation(s)
  • BROMENN HEALTHCARE - (Acute Care)
    1304 FRANKLIN AVENUE
    NORMAL, IL 61761
  • ST JOSEPH MEDICAL CENTER - (Acute Care)
    2200 E WASHINGTON
    BLOOMINGTON, IL 61701
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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