Provider Demographics
NPI:1942450895
Name:EUSTAQUIO, MARC S (DPM)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:EUSTAQUIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3545 BEELER CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3489
Mailing Address - Country:US
Mailing Address - Phone:217-390-2769
Mailing Address - Fax:
Practice Address - Street 1:7375 W 52ND AVE STE 350
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3702
Practice Address - Country:US
Practice Address - Phone:303-423-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005382213ES0103X
COPOD-688213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70909067Medicaid
CO020493OtherKAISER COMMERCIAL NUMBER
CO70909067Medicaid