Healthcare Provider Details

I. General information

NPI: 1124223292
Provider Name (Legal Business Name): JEANNIE M. OROURKE, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S PERRY ST SUITE 500
CASTLE ROCK CO
80104-1901
US

IV. Provider business mailing address

755 S PERRY ST SUITE 500
CASTLE ROCK CO
80104-1901
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-1082
  • Fax: 303-814-0020
Mailing address:
  • Phone: 303-814-1082
  • Fax: 303-814-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberCO 481
License Number StateCO

VIII. Authorized Official

Name: MR. ROBERT ANTON LYTIKAINEN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 303-814-1082