Provider Demographics
NPI:1992894869
Name:EAGLE-SUMMIT FOOT & ANKLE, P.C.
Entity type:Organization
Organization Name:EAGLE-SUMMIT FOOT & ANKLE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-949-0500
Mailing Address - Street 1:3701 ALGONQUIN RD STE 470
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3152
Mailing Address - Country:US
Mailing Address - Phone:888-453-0080
Mailing Address - Fax:224-732-1399
Practice Address - Street 1:50 BUCK CREEK ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-9999
Practice Address - Country:US
Practice Address - Phone:970-949-0500
Practice Address - Fax:970-949-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1304950001Medicare NSC
COA4003Medicare ID - Type Unspecified