Provider Demographics
NPI:1063425882
Name:RHODES, CHARLES MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MILTON
Last Name:RHODES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7030
Mailing Address - Country:US
Mailing Address - Phone:606-836-9613
Mailing Address - Fax:606-836-0026
Practice Address - Street 1:800 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7030
Practice Address - Country:US
Practice Address - Phone:606-836-9613
Practice Address - Fax:606-836-0026
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20144207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64201445Medicaid
OH0531713Medicaid
KY000000632184OtherANTHEM
01136001Medicare PIN
OH0531713Medicaid
KY000000632184OtherANTHEM