Provider Demographics
NPI:1154468270
Name:DAVIS, DANIEL H (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:H
Last Name:DAVIS
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:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:812-375-3477
Practice Address - Street 1:2450 NORTHPARK DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2292
Practice Address - Country:US
Practice Address - Phone:812-376-3311
Practice Address - Fax:812-376-4125
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048628207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000984492OtherANTHEM PIN
IN200188600AMedicaid
IN200188600AMedicaid
ININ2762035Medicare PIN
IN252300AMedicare PIN