Provider Demographics
NPI:1245123389
Name:KINETIC FOOT AND ANKLE CLINIC LLC
Entity type:Organization
Organization Name:KINETIC FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:720-295-4864
Mailing Address - Street 1:5420 S QUEBEC ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1902
Mailing Address - Country:US
Mailing Address - Phone:720-295-4864
Mailing Address - Fax:855-805-9391
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 202
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:720-295-4864
Practice Address - Fax:855-805-9391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINETIC FOOT AND ANKLE CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty