Provider Demographics
NPI:1497715205
Name:STAHL, DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STAHL
Suffix:
Gender:M
Credentials:DO
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 608
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-0608
Mailing Address - Country:US
Mailing Address - Phone:765-932-7591
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:110 E 13TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2126
Practice Address - Country:US
Practice Address - Phone:765-932-7591
Practice Address - Fax:765-932-7505
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ02001999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000331182OtherANTHEM
IN200265090BMedicaid
ININ02001999OtherIN LIC #
IN356004464OtherTAX ID
IN941000SSSMedicare ID - Type Unspecified
IN200265090BMedicaid