Healthcare Provider Details

I. General information

NPI: 1457746844
Provider Name (Legal Business Name): TRAVIS KOTTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920-8075
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-4455
  • Fax:
Mailing address:
  • Phone: 719-632-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000845
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: