Provider Demographics
NPI:1063686947
Name:SOTAK, DANIEL HENRY (MT/AMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HENRY
Last Name:SOTAK
Suffix:
Gender:M
Credentials:MT/AMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13392 N BADGER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8809
Mailing Address - Country:US
Mailing Address - Phone:317-610-9887
Mailing Address - Fax:
Practice Address - Street 1:13392 N BADGER GROVE DR
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8809
Practice Address - Country:US
Practice Address - Phone:317-610-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12345246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist