Provider Demographics
NPI:1821188558
Name:HALVERSON, CHARLES MILO (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MILO
Last Name:HALVERSON
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 1:1540 NORTH BELL STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-3537
Mailing Address - Country:US
Mailing Address - Phone:402-721-7171
Mailing Address - Fax:402-721-7233
Practice Address - Street 1:1540 NORTH BELL STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3537
Practice Address - Country:US
Practice Address - Phone:402-721-7171
Practice Address - Fax:402-721-7233
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE226213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480022398OtherRR MEDICARE
NE91174800200Medicaid
480022397OtherRR MEDICARE
NE91174800200Medicaid
NE4501080001Medicare NSC
NE268444Medicare PIN