MEDICARE: DANIEL FELLHAUER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	23927	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861444556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL FELLHAUER MD

Provider Business Mailing Address
First Line	:	6 ELM AVE STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3120
Country	:	US
Telephone Number	:	719-576-7006
Fax Number	:	719-576-7981

Provider Business Practice Location Address
First Line	:	6 ELM AVE STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3120
Country	:	US
Telephone Number	:	719-576-7006
Fax Number	:	719-576-7981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/23/2022

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