MEDICARE: KENNETH N COATES

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	213E00000X	Podiatrist	393	CO

General Provider Information

NPI Number	:	1770755183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH N COATES

Provider Business Mailing Address
First Line	:	1512 N UNION BLVD
Second Line	:	STE 100
City	:	COLORADO SPGS
State	:	CO
Zip	:	80909-2884
Country	:	US
Telephone Number	:	719-632-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 N UNION BLVD
Second Line	:	STE 100
City	:	COLORADO SPGS
State	:	CO
Zip	:	80909-2884
Country	:	US
Telephone Number	:	719-632-7878
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH N COATES
Credential	:
Telephone Number	:	719-632-7878

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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Directions to “KENNETH N COATES ” Practice Location

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