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General NPI Number Information
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NPI Number | 1003294083
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE INSTITUTE OF COLORADO, PC
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 1465 KELLY JOHNSON BLVD STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3945
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Country | US
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Telephone | 719-488-4664
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Fax | 719-488-4667
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Provider Business Mailing Address
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Address Line | 1465 KELLY JOHNSON BLVD STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3945
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Country | US
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Telephone | 719-488-4664
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Fax | 719-488-4667
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MATTHEW DIEHL HINDERLAND
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Credential | D.P.M.
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Telephone | 719-488-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 707
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License Number State | CO
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