Provider Demographics
NPI:1053335463
Name:DJODJEVA, DANIELA GUEORGUIEVA (MD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELA
Middle Name:GUEORGUIEVA
Last Name:DJODJEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13091 PINNER AVE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037
Mailing Address - Country:US
Mailing Address - Phone:317-900-1206
Mailing Address - Fax:317-773-0844
Practice Address - Street 1:12574 PROMISE CREEK LN STE 110
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-7713
Practice Address - Country:US
Practice Address - Phone:317-900-1206
Practice Address - Fax:317-773-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000335291OtherANTHEM
IN200484360Medicaid
INM400047982Medicare PIN
IN200484360Medicaid
IN218900AMedicare PIN