Provider Demographics
NPI:1740786383
Name:FIKE, CHALON JOHN (MD)
Entity Type:Individual
Prefix:
First Name:CHALON
Middle Name:JOHN
Last Name:FIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.J.
Other - Middle Name:
Other - Last Name:FIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1835 FRANKS PKWY
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6249
Mailing Address - Country:US
Mailing Address - Phone:800-237-8662
Mailing Address - Fax:
Practice Address - Street 1:1835 FRANKS PKWY
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6249
Practice Address - Country:US
Practice Address - Phone:800-237-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35141319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444204Medicaid