MEDICARE: FOUR CORNERS FOOT AND ANKLE P.C.

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	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies	POD710	CO
3	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629416342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR CORNERS FOOT AND ANKLE P.C.

Provider Business Mailing Address
First Line	:	1266 ESCALANTE DR
Second Line	:	SUITE 201
City	:	DURANGO
State	:	CO
Zip	:	81301-7490
Country	:	US
Telephone Number	:	970-259-5303
Fax Number	:	970-259-3510

Provider Business Practice Location Address
First Line	:	1266 ESCALANTE DR
Second Line	:	SUITE 201
City	:	DURANGO
State	:	CO
Zip	:	81301-7490
Country	:	US
Telephone Number	:	970-259-5303
Fax Number	:	970-259-3510

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAYSE L LAKE
Credential	:	DPM
Telephone Number	:	970-259-5303

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	02/19/2026

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Directions to “FOUR CORNERS FOOT AND ANKLE P.C. ” Practice Location

Language	Start Address	Practice Location

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