Provider Demographics
NPI:1154868891
Name:COLORADO FOOT AND ANKLE SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:COLORADO FOOT AND ANKLE SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:720-999-0548
Mailing Address - Street 1:19284 COTTONWOOD DR STE 201B
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3825
Mailing Address - Country:US
Mailing Address - Phone:720-822-0735
Mailing Address - Fax:866-214-1528
Practice Address - Street 1:19284 COTTONWOOD DR STE 201B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3825
Practice Address - Country:US
Practice Address - Phone:720-822-0735
Practice Address - Fax:866-214-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO752213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty