Provider Demographics
NPI:1366683088
Name:KEITH A NAFTULIN, DPM, PC
Entity Type:Organization
Organization Name:KEITH A NAFTULIN, DPM, PC
Other - Org Name:MEDICAL AND SURGICAL FOOT AND ANKLE CARE, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAFTULIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-932-7957
Mailing Address - Street 1:6169 S BALSAM WAY STE 290
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3064
Mailing Address - Country:US
Mailing Address - Phone:303-932-7957
Mailing Address - Fax:303-933-8271
Practice Address - Street 1:6169 S BALSAM WAY
Practice Address - Street 2:270
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3062
Practice Address - Country:US
Practice Address - Phone:303-932-7957
Practice Address - Fax:303-933-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO472213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01004720Medicaid
COU46785Medicare UPIN
CO01004720Medicaid