Healthcare Provider Details

I. General information

NPI: 1740268002
Provider Name (Legal Business Name): BRIAN C MEHLHAUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S STORY ST
BOONE IA
50036-4739
US

IV. Provider business mailing address

120 S STORY ST
BOONE IA
50036-4739
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-4444
  • Fax: 515-432-1331
Mailing address:
  • Phone: 515-432-4444
  • Fax: 515-432-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-28190
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: