Provider Demographics
NPI:1356600118
Name:MCALLISTER, BENJAMIN ETHAN (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ETHAN
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL SQ STE 50
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1357
Mailing Address - Country:US
Mailing Address - Phone:317-468-6257
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:120 W MCKENZIE RD STE F
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1072
Practice Address - Country:US
Practice Address - Phone:317-468-6200
Practice Address - Fax:317-468-6201
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004445A2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program