| NPI | 1396560017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYSE L LAKE Owner 719-559-3388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2025-07-11 |