Provider Demographics
NPI:1578554762
Name:ABODEELY, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ABODEELY
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-984-8827
Mailing Address - Fax:314-984-0736
Practice Address - Street 1:9930 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1827
Practice Address - Country:US
Practice Address - Phone:314-984-8827
Practice Address - Fax:314-984-0736
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO346202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206589OtherHEALTHLINK
MO5872678OtherAETNA
MO200258010Medicaid
MO1600797OtherUHC
MO000000010593OtherESSENCE
MO65413OtherGHP
MO144352OtherBCBS
MO5206V34311OtherHEALTHCARE USA
MOA12785OtherMERCY MC PL
MO044012451Medicare PIN
MO300122587Medicare PIN
MO200258010Medicaid
MOA12785OtherMERCY MC PL
MO1600797OtherUHC