Provider Demographics
NPI:1902881915
Name:HORWITZ, LON RANDOLPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:RANDOLPH
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MILWAUKEE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5008
Mailing Address - Country:US
Mailing Address - Phone:393-393-6677
Mailing Address - Fax:303-393-8637
Practice Address - Street 1:222 MILWAUKEE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5008
Practice Address - Country:US
Practice Address - Phone:393-393-6677
Practice Address - Fax:303-393-8637
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO506213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003573Medicaid
CO01003573Medicaid
CO52853Medicare PIN