MEDICARE: CHARLES T ALLEN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016004865	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	480026190	OTHER	IL	RAILROAD MEDICARE
5	P00712946	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60010797	OTHER	IL	BLUE CROSS BLUE SHIELD
2	N396441	OTHER	IL	HARMONY HEALTH
3	01638903	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144345364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES T ALLEN DPM

Provider Business Mailing Address
First Line	:	5700 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2408
Country	:	US
Telephone Number	:	773-925-5700
Fax Number	:	773-925-5775

Provider Business Practice Location Address
First Line	:	5700 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2408
Country	:	US
Telephone Number	:	773-925-5700
Fax Number	:	773-925-5775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	12/09/2021

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Directions to “ CHARLES T ALLEN DPM” Practice Location

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