Healthcare Provider Details

I. General information

NPI: 1548433469
Provider Name (Legal Business Name): DUSTIN KRUSE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7615 W 38TH AVE SUITE B133
WHEAT RIDGE CO
80033-6172
US

IV. Provider business mailing address

7615 W 38TH AVE SUITE B133
WHEAT RIDGE CO
80033-6172
US

V. Phone/Fax

Practice location:
  • Phone: 303-423-2520
  • Fax: 303-423-2536
Mailing address:
  • Phone: 303-423-2520
  • Fax: 303-423-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number696
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: