Provider Demographics
NPI:1942196068
Name:JALLOW, ALIEU
Entity type:Individual
Prefix:
First Name:ALIEU
Middle Name:
Last Name:JALLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 COLONY CIR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3083
Mailing Address - Country:US
Mailing Address - Phone:608-212-8307
Mailing Address - Fax:
Practice Address - Street 1:1796 COLONY CIR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-3083
Practice Address - Country:US
Practice Address - Phone:608-212-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver