MEDICARE: JEANNIE M. OROURKE, DPM PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	CO 481	CO

General Provider Information

NPI Number	:	1124223292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANNIE M. OROURKE, DPM PC

Provider Business Mailing Address
First Line	:	755 S PERRY ST
Second Line	:	SUITE 500
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1901
Country	:	US
Telephone Number	:	303-814-1082
Fax Number	:	303-814-0020

Provider Business Practice Location Address
First Line	:	755 S PERRY ST
Second Line	:	SUITE 500
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1901
Country	:	US
Telephone Number	:	303-814-1082
Fax Number	:	303-814-0020

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. ROBERT ANTON LYTIKAINEN
Credential	:
Telephone Number	:	303-814-1082

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/19/2008

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