Provider Demographics
NPI:1326121682
Name:IVAN, DANIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:IVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIELA
Other - Middle Name:DUSE
Other - Last Name:IVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 N HIGLEY ROAD
Mailing Address - Street 2:ATTN: HOSPITALISTS
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-543-2034
Mailing Address - Fax:480-543-2647
Practice Address - Street 1:1900 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1604
Practice Address - Country:US
Practice Address - Phone:480-543-2034
Practice Address - Fax:480-543-2647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37560207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147533Medicare PIN
AZZ118151Medicare PIN
AZI65007Medicare UPIN