Provider Demographics
NPI:1225021223
Name:ALLISON, CHARLES H (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:ALLISON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4309
Mailing Address - Country:US
Mailing Address - Phone:563-219-8903
Mailing Address - Fax:
Practice Address - Street 1:216 5TH AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4309
Practice Address - Country:US
Practice Address - Phone:563-219-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001133A213ES0103X
IA00619213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN07001133Medicaid
INP01633656OtherRAILROAD MEDICARE
IN201045280Medicaid
IN234760010Medicare PIN
IN859800005Medicare PIN
IAU59380Medicare UPIN
IN201045280Medicaid