Provider Demographics
NPI:1417023581
Name:GAY, DANIEL A (DO, FACP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:GAY
Suffix:
Gender:M
Credentials:DO, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1199 HADLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1788
Practice Address - Country:US
Practice Address - Phone:317-834-3263
Practice Address - Fax:317-834-5194
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002405207U00000X, 207R00000X
IN02002405A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200324060Medicaid
KY64030406OtherKY MEDICAID
IN000000190965OtherANTHEM IM IDENTIFICATION
IN000000277881OtherANTHEM NUC MED ID
KY64030406OtherKY MEDICAID