Healthcare Provider Details

I. General information

NPI: 1598403990
Provider Name (Legal Business Name): FRONT RANGE PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 SOUTHPARK LN UNIT 250
LITTLETON CO
80120-4534
US

IV. Provider business mailing address

8151 SOUTHPARK LN UNIT 250
LITTLETON CO
80120-4534
US

V. Phone/Fax

Practice location:
  • Phone: 720-662-7184
  • Fax: 720-662-7616
Mailing address:
  • Phone: 720-662-7184
  • Fax: 720-662-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID M SHAIN
Title or Position: CO-OWNER
Credential: DPM
Phone: 720-662-7184