Provider Demographics
NPI:1568476091
Name:TIRONE, CHARLES M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:TIRONE
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 1:2865 CHANCELLOR DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:859-341-9900
Mailing Address - Fax:859-341-1649
Practice Address - Street 1:2865 CHANCELLOR DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-1931
Practice Address - Country:US
Practice Address - Phone:859-341-9900
Practice Address - Fax:859-341-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244020213E00000X, 213ER0200X, 213ES0103X, 213ES0131X, 213EP1101X, 213ES0131X
KYKY00164213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2720114OtherDEFINITY HEALTH
000000065431OtherCENTRAL STATES
000000065431Other2ND CENTRAL STATES HEALTH
672301002OtherCIGNA
KY80001647Medicaid
000000065431OtherANTHEM
000000065431OtherEXECUTIVE AND EMPLOYEE BE
000000065431OtherBLUE CROSS BLUE SHIELD
611317095-01OtherBWC/CAREWORKS
G302OtherEMPIRE BLUE CROSS/BLUE SH
K0164OtherCHOICE CARE
0672301002OtherCONNECTICUT GENERAL LIFE
6113170957B12OtherBLUE CROSS/BLUE SHIELD PP
2160772OtherAETNA
2160772OtherAMERICAN HEALTH ADMIN
000000065431OtherBLUE CROSS BLUE SHIELD
2160772OtherAMERICAN HEALTH ADMIN
K0164OtherCHOICE CARE
G302OtherEMPIRE BLUE CROSS/BLUE SH
000000065431OtherCENTRAL STATES