Provider Demographics
NPI:1497857650
Name:ALLYN, DUANE R (DO)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:R
Last Name:ALLYN
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 1:2184 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3437
Mailing Address - Country:US
Mailing Address - Phone:810-232-5627
Mailing Address - Fax:810-232-8024
Practice Address - Street 1:2184 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3437
Practice Address - Country:US
Practice Address - Phone:810-232-5627
Practice Address - Fax:810-232-8024
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235323Medicaid
MI3235323Medicaid
MIM23560004Medicare PIN