Healthcare Provider Details

I. General information

NPI: 1710776851
Provider Name (Legal Business Name): KATHERINE MARIE MELIA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N BANNOCK ST. PAVILION L, FLOOR 6
DENVER CO
80204
US

IV. Provider business mailing address

777 BANNOCK ST # MC0188
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPDT.0000633
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPDT.0000633
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPDT.0000633
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPDT.0000633
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: