MEDICARE: KURT M. NELLHAUS, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053312314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURT M. NELLHAUS, M.D.

Provider Business Mailing Address
First Line	:	PO BOX 890805
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28289-0805
Country	:	US
Telephone Number	:	216-464-5160
Fax Number	:	216-464-5982

Provider Business Practice Location Address
First Line	:	3100 MACCORKLE AVE SE
Second Line	:	SUITE 806
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1223
Country	:	US
Telephone Number	:	304-344-9480
Fax Number	:	304-344-9481

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KURT NELLHAUS
Credential	:	M.D.
Telephone Number	:	304-344-9480

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/21/2022

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