Provider Demographics
NPI:1487681565
Name:ALLEN, MICHAEL C (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
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 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE C115
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-8855
Mailing Address - Fax:
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE C115
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-8855
Practice Address - Fax:859-278-8856
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00236213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002363Medicaid
KY0656901Medicare ID - Type Unspecified
KY80002363Medicaid