Provider Demographics
NPI:1053687210
Name:DREW, DANIEL CONNOR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CONNOR
Last Name:DREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7168 GRAHAM RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2686
Mailing Address - Country:US
Mailing Address - Phone:317-441-3663
Mailing Address - Fax:317-568-0849
Practice Address - Street 1:7168 GRAHAM RD
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2686
Practice Address - Country:US
Practice Address - Phone:317-441-3663
Practice Address - Fax:317-568-0849
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01021465OtherSTATE LISCENSE