Healthcare Provider Details

I. General information

NPI: 1790097087
Provider Name (Legal Business Name): DANIEL CHARLES CHELIUS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 TANGLEWILDE ST 160
HOUSTON TX
77063-2100
US

IV. Provider business mailing address

2500 TANGLEWILDE ST 160
HOUSTON TX
77063-2100
US

V. Phone/Fax

Practice location:
  • Phone: 713-781-9660
  • Fax: 713-974-3672
Mailing address:
  • Phone: 713-781-9660
  • Fax: 713-974-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number2010015930
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number04-35115
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberP2212
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberP2212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: