Basic Information
| Provider Information | |||||||||
| NPI: | 1205192192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOEHN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 FOX ROAD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192325291 | ||||||||
| FaxNumber: | 4192325292 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 FOX ROAD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192325291 | ||||||||
| FaxNumber: | 4192325292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2012 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 003593 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0064945 | 05 | OH | MEDICAID |