Provider Demographics
NPI:1215321856
Name:FOOT AND ANKLE SPECIALISTS OF COLORADO PLLC
Entity type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF COLORADO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-275-1037
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-0576
Mailing Address - Country:US
Mailing Address - Phone:719-275-1037
Mailing Address - Fax:719-275-1305
Practice Address - Street 1:604 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4910
Practice Address - Country:US
Practice Address - Phone:719-275-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000747213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty