Provider Demographics
NPI:1598403990
Name:FRONT RANGE PODIATRY PLLC
Entity type:Organization
Organization Name:FRONT RANGE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:720-662-7184
Mailing Address - Street 1:8151 SOUTHPARK LN UNIT 250
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4534
Mailing Address - Country:US
Mailing Address - Phone:720-662-7184
Mailing Address - Fax:720-662-7616
Practice Address - Street 1:8151 SOUTHPARK LN UNIT 250
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4534
Practice Address - Country:US
Practice Address - Phone:720-662-7184
Practice Address - Fax:720-662-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty