MEDICARE: PIKES PEAK FOOT AND ANKLE CTR

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PIA0503	OTHER	CO	BLUE CROSS BLUE SHELID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730368093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK FOOT AND ANKLE CTR

Provider Business Mailing Address
First Line	:	455 E PIKES PEAK AVE
Second Line	:	SUITE 220
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3648
Country	:	US
Telephone Number	:	719-475-8080
Fax Number	:	719-475-0913

Provider Business Practice Location Address
First Line	:	455 E PIKES PEAK AVE
Second Line	:	SUITE 220
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3648
Country	:	US
Telephone Number	:	719-475-8080
Fax Number	:	719-475-0913

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ERIC GESSNER
Credential	:	DPM
Telephone Number	:	719-475-8080

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	06/29/2011

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Directions to “PIKES PEAK FOOT AND ANKLE CTR ” Practice Location

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