Healthcare Provider Details

I. General information

NPI: 1396560017
Provider Name (Legal Business Name): FOOT & ANKLE CENTER OF COLORADO SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 TUTT BLVD STE 250
COLORADO SPRINGS CO
80923-1500
US

IV. Provider business mailing address

1266 ESCALANTE DR
DURANGO CO
81303-8933
US

V. Phone/Fax

Practice location:
  • Phone: 719-559-3388
  • Fax: 719-559-3509
Mailing address:
  • Phone: 719-559-3388
  • Fax: 719-559-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KAYSE L LAKE
Title or Position: OWNER
Credential: DPM
Phone: 719-559-3388