Basic Information
| Provider Information | |||||||||
| NPI: | 1730336389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROKOP | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 WHEELING ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800457211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208575000 | ||||||||
| FaxNumber: | 3033408158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 WHEELING ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800457211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208575000 | ||||||||
| FaxNumber: | 3033408158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 12/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 448 | CO | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.