Provider Demographics
NPI:1730188814
Name:SUNDERHAUS-COLLINS, CHANDRA (DO)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:SUNDERHAUS-COLLINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3134
Mailing Address - Country:US
Mailing Address - Phone:719-630-2387
Mailing Address - Fax:719-630-2328
Practice Address - Street 1:325 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3134
Practice Address - Country:US
Practice Address - Phone:719-630-2387
Practice Address - Fax:719-630-2328
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41580208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22137246Medicaid
CO22137246Medicaid
CO800639Medicare ID - Type Unspecified