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General NPI Number Information
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NPI Number | 1942450895
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Entity Type | Individual
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Provider Name | MARC S EUSTAQUIO DPM
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Gender | Male
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 7375 W 52ND AVE STE 350
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City | ARVADA
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State | CO
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Zip | 80002-3702
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Country | US
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Telephone | 303-423-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 3545 BEELER CT
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City | DENVER
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State | CO
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Zip | 80238-3489
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Country | US
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Telephone | 217-390-2769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 016.005382
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-688
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License Number State | CO
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