Provider Demographics
NPI:1588022826
Name:DAUM, DAN
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:DAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E JOHNSTOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3815
Mailing Address - Country:US
Mailing Address - Phone:614-584-7989
Mailing Address - Fax:
Practice Address - Street 1:830 E JOHNSTOWN RD STE C
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3815
Practice Address - Country:US
Practice Address - Phone:614-584-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015116 C-D172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker