Provider Demographics
NPI:1417953605
Name:VANHOUDEN, CHARLES EARL (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EARL
Last Name:VANHOUDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:E
Other - Last Name:VANHOUDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0946
Mailing Address - Country:US
Mailing Address - Phone:620-431-2500
Mailing Address - Fax:620-431-0914
Practice Address - Street 1:505 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1950
Practice Address - Country:US
Practice Address - Phone:620-431-2500
Practice Address - Fax:620-431-0914
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0417383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100087520AMedicaid
KS003263OtherBLUE CROSS & BLUE SHIELD
020020291OtherRAIL ROAD MEDICARE
KS600530OtherFIRSTGUARD
66720A018OtherTRICARE
66720A018OtherTRICARE
KS003263OtherBLUE CROSS & BLUE SHIELD