Provider Demographics
NPI:1346539517
Name:NIEHAUS, WILLIAM N (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:NIEHAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 E. 17TH AVE., ACADEMIC OFFICE ONE
Mailing Address - Street 2:MAIL STOP F493 C/O MALLORY PRIDY
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12631 E. 17TH AVE., ACADEMIC OFFICE ONE
Practice Address - Street 2:MAIL STOP F493 C/O MALLORY PRIDY
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-583-4287
Practice Address - Fax:888-310-3542
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052588208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program