Provider Demographics
NPI:1730173519
Name:JELINEK, ROBERT ALAN (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:JELINEK
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 1:350 BROADWAY ST
Mailing Address - Street 2:STE 208
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-3338
Mailing Address - Country:US
Mailing Address - Phone:303-499-4448
Mailing Address - Fax:303-499-5123
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:#208
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3343
Practice Address - Country:US
Practice Address - Phone:303-499-4448
Practice Address - Fax:303-499-5123
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO465213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01004654Medicaid
U39756Medicare UPIN
CO01004654Medicaid