Provider Demographics
NPI:1508037136
Name:MIRE, DANIELLE MARIE (MD, MSED)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MARIE
Last Name:MIRE
Suffix:
Gender:F
Credentials:MD, MSED
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Other - First Name:
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Mailing Address - Street 1:819 MOUNT TABOR RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6414
Mailing Address - Country:US
Mailing Address - Phone:812-590-3385
Mailing Address - Fax:812-590-3373
Practice Address - Street 1:819 MOUNT TABOR RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6414
Practice Address - Country:US
Practice Address - Phone:812-590-3385
Practice Address - Fax:812-590-3373
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA2012862084P0804X
KY430532084P0804X
IN01068598A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry