Provider Demographics
NPI:1144345364
Name:ALLEN, CHARLES T (DPM)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2408
Mailing Address - Country:US
Mailing Address - Phone:773-925-5700
Mailing Address - Fax:773-925-5775
Practice Address - Street 1:5700 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2408
Practice Address - Country:US
Practice Address - Phone:773-925-5700
Practice Address - Fax:773-925-5775
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004865213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60010797OtherBLUE CROSS BLUE SHIELD
ILN396441OtherHARMONY HEALTH
IL01638903OtherBLUE CROSS BLUE SHIELD
IL480026190OtherRAILROAD MEDICARE
ILP00712946OtherRAILROAD MEDICARE
ILP00712946OtherRAILROAD MEDICARE
IL60010797OtherBLUE CROSS BLUE SHIELD
IL206733Medicare PIN