Healthcare Provider Details

I. General information

NPI: 1487681565
Provider Name (Legal Business Name): MICHAEL C ALLEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD SUITE C115
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

1401 HARRODSBURG RD SUITE C115
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8855
  • Fax: 859-278-8856
Mailing address:
  • Phone: 859-278-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00236
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00236
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: