ALLISON, KENNETH S JR (MD)

Provider Demographics

• NPI: 1134398365
• Name: ALLISON, KENNETH S JR (MD)
• Entity type: Individual
• First Name: KENNETH
• Middle Name: S
• Last Name: ALLISON
• Suffix: JR
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 10800 E GEDDES AVE STE 300
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80112-3895
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2008-02-21
• Last Update Date: 2022-12-07

Provider Licenses

State	License ID	Taxonomies
MA	234771	2085R0202X
CO	53456	2085R0202X
NE	27766	2085R0202X
KS	04-37111	2085R0202X
TN	54275	2085R0202X
TX	R1162	2085R0202X
HI	MD15618	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CO	74531735	Medicaid
NE	100262773-00	Medicaid
NE	100262778-00	Medicaid
NE	840897126-00	Medicaid
MT	1134398365	Medicaid
NE	100257090-00	Medicaid
NE	100262774-00	Medicaid
NM	1134398365	Medicaid
NE	840597929-13	Medicaid
HI	00H0292923	Other	HMSA HAWAII
HI	00H0292923	Other	HMSA ALL PRODUCTS
WY	1134398365	Medicaid
UT	1134398365	Medicaid
KS	201096030A	Medicaid
NE	100262776-00	Medicaid
AZ	911135	Medicaid
NE	NA1214085	Medicare PIN
WY	1134398365	Medicaid
NE	NA2517001	Medicare PIN
NE	P01348683	Medicare PIN
CO	74531735	Medicaid
NE	840897126-00	Medicaid
UT	1134398365	Medicaid
NE	840597929-13	Medicaid
NE	NA1215085	Medicare PIN
CO	347233YQPG	Medicare PIN
HI	H104997	Medicare PIN
NE	100262773-00	Medicaid
CO	P01329756	Medicare PIN
KS	KA3249024	Medicare PIN