MEDICARE: CHARLES LAYTON ELLIOTT MD

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	207Y00000X	Otolaryngology Physician	01031986A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144226317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LAYTON ELLIOTT MD

Provider Business Mailing Address
First Line	:	138 N DIXON RD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46901-4154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 N DIXON RD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46901-4154
Country	:	US
Telephone Number	:	765-236-8282
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/20/2022

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