Provider Demographics
NPI:1225432057
Name:PRO ACTIVE PODIATRY PC
Entity Type:Organization
Organization Name:PRO ACTIVE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARICHART
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIKAYEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:720-600-2240
Mailing Address - Street 1:1476 S JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2428
Mailing Address - Country:US
Mailing Address - Phone:720-600-2240
Mailing Address - Fax:720-310-2162
Practice Address - Street 1:7120 E ORCHARD RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1731
Practice Address - Country:US
Practice Address - Phone:720-600-2240
Practice Address - Fax:720-310-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty