Provider Demographics
NPI:1740268002
Name:MEHLHAUS, BRIAN C (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:MEHLHAUS
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 1:120 S STORY ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4739
Mailing Address - Country:US
Mailing Address - Phone:515-432-4444
Mailing Address - Fax:515-432-1331
Practice Address - Street 1:120 S STORY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4739
Practice Address - Country:US
Practice Address - Phone:515-432-4444
Practice Address - Fax:515-432-1331
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-28190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080105650OtherRR MEDICARE
IA3072835Medicaid
IA58686Medicare PIN
IAD94696Medicare UPIN