Individual
CHARLES T ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5700 S KEDZIE AVE, CHICAGO, IL 60629-2408
(773) 925-5700
(773) 925-5775
Mailing address
5700 S KEDZIE AVE, CHICAGO, IL 60629-2408
(773) 925-5700
(773) 925-5775
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016004865
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01638903
BLUE CROSS BLUE SHIELD
IL
01
—
480026190
RAILROAD MEDICARE
IL
01
—
60010797
BLUE CROSS BLUE SHIELD
IL
01
—
N396441
HARMONY HEALTH
IL
01
—
P00712946
RAILROAD MEDICARE
IL
Enumeration date
03/20/2007
Last updated
12/09/2021
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