Provider Demographics
NPI:1164441275
Name:TKACH, DANIEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:TKACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2601 KENTUCKY AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3827
Mailing Address - Country:US
Mailing Address - Phone:270-444-8200
Mailing Address - Fax:270-444-8398
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:STE 401
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3827
Practice Address - Country:US
Practice Address - Phone:270-444-8200
Practice Address - Fax:270-444-8398
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY30632208200000X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
164277500OtherUS DEPT OF LABOR
240006752OtherRAILROAD MEDICARE
KY64306327Medicaid
KY000000200472OtherBLUE CROSS
F84448Medicare UPIN
240006752OtherRAILROAD MEDICARE