Provider Demographics
NPI:1629038849
Name:HOUSE, MARC R (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:R
Last Name:HOUSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12510 E ILIFF AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6377
Mailing Address - Country:US
Mailing Address - Phone:720-295-4864
Mailing Address - Fax:855-805-9391
Practice Address - Street 1:12510 E ILIFF AVE STE 120
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6377
Practice Address - Country:US
Practice Address - Phone:720-295-4864
Practice Address - Fax:855-805-9391
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000972A213ES0103X
COPOD.0000737213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0812540001Medicare NSC
INV00931Medicare UPIN
IN521880LMedicare PIN
INP00151363Medicare PIN
IN200490880Medicaid