MEDICARE: CHARLES MICHAEL ALLEN

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	172A00000X	Driver	02605766	SD
2	344600000X	Taxi

General Provider Information

NPI Number	:	1811759178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MICHAEL ALLEN

Provider Business Mailing Address
First Line	:	5530 E BLARNEY PL APT 2
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-3716
Country	:	US
Telephone Number	:	605-231-3515
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 E BLARNEY PL APT 2
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-3716
Country	:	US
Telephone Number	:	605-231-3515
Fax Number	:

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	06/12/2024

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Directions to “ CHARLES MICHAEL ALLEN ” Practice Location

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