Healthcare Provider Details

I. General information

NPI: 1114156726
Provider Name (Legal Business Name): TREVOR KEITH WHITING D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 KELLY JOHNSON BLVD STE 100
COLORADO SPRINGS CO
80920-3945
US

IV. Provider business mailing address

1465 KELLY JOHNSON BLVD STE 100
COLORADO SPRINGS CO
80920-3945
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-4664
  • Fax: 719-488-4667
Mailing address:
  • Phone: 719-488-4664
  • Fax: 719-488-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002330
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberOP60294170
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD.0000886
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: