Healthcare Provider Details

I. General information

NPI: 1982963229
Provider Name (Legal Business Name): ELIZABETH HAUSLEIN BUELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ELLEN HAUSLEIN M.D.

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W. LAKE STREET
FORT COLLINS CO
80523-8031
US

IV. Provider business mailing address

CAMPUS DELIVERY 8031
FORT COLLINS CO
80523-8031
US

V. Phone/Fax

Practice location:
  • Phone: 970-491-7121
  • Fax:
Mailing address:
  • Phone: 970-491-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0053065
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: