Healthcare Provider Details

I. General information

NPI: 1841479037
Provider Name (Legal Business Name): CARLSEN FOOT & ANKLE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 CHAPEL HILLS DR SUITE A
COLORADO SPRINGS CO
80920-3765
US

IV. Provider business mailing address

1802 CHAPEL HILLS DR SUITE A
COLORADO SPRINGS CO
80920-3765
US

V. Phone/Fax

Practice location:
  • Phone: 719-260-6604
  • Fax: 719-471-9314
Mailing address:
  • Phone: 719-260-6604
  • Fax: 719-471-9314

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: DR. TIM J CARLSEN
Title or Position: PRESIDENT
Credential: DPM
Phone: 719-260-6604