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NPI Code Detail

MEDICARE: KELLY NOONAN D.P.M.

MEDICARE: KELLY NOONAN D.P.M.
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
1213ES0103XFoot & Ankle Surgery Podiatrist169WY
2213ES0103XFoot & Ankle Surgery Podiatrist2490MA
3213ES0103XFoot & Ankle Surgery PodiatristPOD.0000925CO

General Provider Information

NPI Number : 1922459973
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY NOONAN D.P.M.
Provider Business Mailing Address
First Line : 2001 S SHIELDS ST STE F
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1833
Country : US
Telephone Number : 970-343-4217
Fax Number :
Provider Business Practice Location Address
First Line : 2001 S SHIELDS ST STE F
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1833
Country : US
Telephone Number : 970-343-4217
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2016
Last Update Date : 04/20/2023

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Directions to “ KELLY NOONAN D.P.M.” Practice Location

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