Healthcare Provider Details

I. General information

NPI: 1033199070
Provider Name (Legal Business Name): TIM CARLSEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 TENDERFOOT HILL ST SUITE 10
COLORADO SPRINGS CO
80906-3981
US

IV. Provider business mailing address

2620 TENDERFOOT HILL ST SUITE 10
COLORADO SPRINGS CO
80906-3981
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-2080
  • Fax: 719-576-2248
Mailing address:
  • Phone: 719-576-2080
  • Fax: 719-576-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number642
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: