MEDICARE: DR. 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	15554	WV
2	207RP1001X	Pulmonary Disease Physician	15554	WV
3	207P00000X	Emergency Medicine Physician	15554	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
2	1508866633	OTHER	WV	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508866633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT M NELLHAUS M.D.

Provider Business Mailing Address
First Line	:	501 MORRIS ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1326
Country	:	US
Telephone Number	:	304-388-3574
Fax Number	:	304-388-6481

Provider Business Practice Location Address
First Line	:	1738 LOUDON HEIGHTS RD
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25314-1546
Country	:	US
Telephone Number	:	304-546-9524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/18/2016

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