Provider Demographics
NPI:1528083276
Name:KLINGELHEBER, BOB FRED (DO)
Entity type:Individual
Prefix:DR
First Name:BOB
Middle Name:FRED
Last Name:KLINGELHEBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 CARIBOU DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-484-4757
Mailing Address - Fax:970-377-3386
Practice Address - Street 1:1024 LEMAY AVENUE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-495-8600
Practice Address - Fax:970-495-7619
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO194342085R0202X
MI51010068522085R0202X
IN02001615A2085R0202X
NE4192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
98633OtherMEDICARE NEBRASKA
CO78038081Medicaid
CO0211OtherHLTH NET MEDICARE HMO
27969599OtherFED COMP DEPT LABOR
98633OtherMEDICARE NEBRASKA
27969599OtherFED COMP DEPT LABOR
CO78038081Medicaid