Healthcare Provider Details

I. General information

NPI: 1023438058
Provider Name (Legal Business Name): DANIELLE WILHOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE DAITCH

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone: 720-493-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberNT207182
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0062212
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberDR.0062212
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: