Provider Demographics
NPI:1861444556
Name:FELLHAUER, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FELLHAUER
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 1:6 ELM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3120
Mailing Address - Country:US
Mailing Address - Phone:719-576-7006
Mailing Address - Fax:719-576-7981
Practice Address - Street 1:6 ELM AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3120
Practice Address - Country:US
Practice Address - Phone:719-576-7006
Practice Address - Fax:719-576-7981
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01239276Medicaid
COJ50008Medicare ID - Type Unspecified
COD24356Medicare UPIN
CO01239276Medicaid