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NPI Code Detail

MEDICARE: DR. TIM CARLSEN D.P.M.

MEDICARE: DR. TIM CARLSEN D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213EP1101XPrimary Podiatric Medicine Podiatrist642CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00147284OTHERCORRW MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3841469291005OTHERCORMHMO
484146929104OTHERCOPACIFICARE

General Provider Information

NPI Number : 1033199070
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIM CARLSEN D.P.M.
Provider Business Mailing Address
First Line : 2620 TENDERFOOT HILL ST
Second Line : SUITE 10
City : COLORADO SPRINGS
State : CO
Zip : 80906-3981
Country : US
Telephone Number : 719-576-2080
Fax Number : 719-576-2248
Provider Business Practice Location Address
First Line : 2620 TENDERFOOT HILL ST
Second Line : SUITE 10
City : COLORADO SPRINGS
State : CO
Zip : 80906-3981
Country : US
Telephone Number : 719-576-2080
Fax Number : 719-576-2248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 07/08/2007

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