Healthcare Provider Details

I. General information

NPI: 1932285418
Provider Name (Legal Business Name): CHARLES STEVEN FEHLAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 E ETIENNE WAY
SANDY UT
84093-1116
US

IV. Provider business mailing address

2773 E ETIENNE WAY
SANDY UT
84093-1116
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-0255
  • Fax: 801-272-0183
Mailing address:
  • Phone: 801-824-2748
  • Fax: 801-272-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number177543-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: