Provider Demographics
NPI:1255301941
Name:GEMBUS, DANIEL WALTER (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WALTER
Last Name:GEMBUS
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 1:2215 E WATERLOO RD
Mailing Address - Street 2:STE 313
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2720
Practice Address - Street 1:195 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9504
Practice Address - Country:US
Practice Address - Phone:330-334-1504
Practice Address - Fax:330-334-2918
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.058947207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0824915Medicaid
OHGE0693153Medicare ID - Type Unspecified
OH0824915Medicaid