Provider Demographics
NPI:1083760417
Name:DANIEL, KURT ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:ROBERT
Last Name:DANIEL
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-6674
Mailing Address - Fax:336-716-9188
Practice Address - Street 1:306 WESTWOOD AVE
Practice Address - Street 2:STE 401
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4342
Practice Address - Country:US
Practice Address - Phone:336-885-6168
Practice Address - Fax:336-885-6402
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC200400482207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891365RMedicaid
NCP00880318OtherRR MEDICARE
NC2401617AMedicare PIN
NCP00880318OtherRR MEDICARE
NCNCF004CMedicare PIN