Provider Demographics
NPI:1548433469
Name:KRUSE, DUSTIN (DPM)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:KRUSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 W 38TH AVE
Mailing Address - Street 2:SUITE B133
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6172
Mailing Address - Country:US
Mailing Address - Phone:303-423-2520
Mailing Address - Fax:303-423-2536
Practice Address - Street 1:7615 W 38TH AVE
Practice Address - Street 2:SUITE B133
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6172
Practice Address - Country:US
Practice Address - Phone:303-423-2520
Practice Address - Fax:303-423-2536
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO696213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO696OtherSTATE LICENSE