Provider Demographics
NPI:1649229303
Name:COMPLETE FOOT AND ANKLE CARE PC
Entity Type:Organization
Organization Name:COMPLETE FOOT AND ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WYLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-322-3800
Mailing Address - Street 1:6825 E TENNESSEE AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1628
Mailing Address - Country:US
Mailing Address - Phone:303-322-3800
Mailing Address - Fax:303-322-3805
Practice Address - Street 1:6825 E TENNESSEE AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1628
Practice Address - Country:US
Practice Address - Phone:303-322-3800
Practice Address - Fax:303-322-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO578213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53252829Medicaid
CO53252829Medicaid
COC805282Medicare PIN