Basic Information
| Provider Information | |||||||||
| NPI: | 1528083276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINGELHEBER | ||||||||
| FirstName: | BOB | ||||||||
| MiddleName: | FRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2008 CARIBOU DRIVE | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704844757 | ||||||||
| FaxNumber: | 9703773386 | ||||||||
| Practice Location | |||||||||
| Address1: | 1024 LEMAY AVENUE | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704958600 | ||||||||
| FaxNumber: | 9704957619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 19434 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 5101006852 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 02001615A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 419 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 98633 | 01 | MEDICARE NEBRASKA | OTHER | 78038081 | 05 | CO | MEDICAID | CO0211 | 01 | HLTH NET MEDICARE HMO | OTHER | 27969599 | 01 | FED COMP DEPT LABOR | OTHER |