| NPI | 1629416342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYSE L LAKE Owner 970-259-5303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD710) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CO POD710) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-04-20 |