Provider Demographics
NPI:1659374924
Name:ZEMAN, CHARLES MICHAEL (DO)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:ZEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7528
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-7528
Mailing Address - Country:US
Mailing Address - Phone:660-665-3267
Mailing Address - Fax:660-665-0260
Practice Address - Street 1:#1 CROWN DRIVE, SUITE 201
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2510
Practice Address - Country:US
Practice Address - Phone:660-665-3267
Practice Address - Fax:660-665-0260
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO100273208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243476405Medicaid
MO243476405Medicaid
MOF19053Medicare UPIN