Provider Demographics
NPI:1518968544
Name:NETLUCH, DANIEL MYRON (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MYRON
Last Name:NETLUCH
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 1:1201 S MAIN ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8481
Mailing Address - Country:US
Mailing Address - Phone:219-757-6310
Mailing Address - Fax:219-757-6312
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8481
Practice Address - Country:US
Practice Address - Phone:219-757-6310
Practice Address - Fax:219-757-6312
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038329A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100387940Medicaid
IN100387940Medicaid
E35973Medicare UPIN