Provider Demographics
NPI:1588657001
Name:STORCH, DANIEL OSCAR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:OSCAR
Last Name:STORCH
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 1:340 E. PALM LANE
Mailing Address - Street 2:SUITE A-175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4612
Mailing Address - Country:US
Mailing Address - Phone:602-386-1100
Mailing Address - Fax:602-386-1150
Practice Address - Street 1:340 E PALM LN
Practice Address - Street 2:SUITE A-175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4603
Practice Address - Country:US
Practice Address - Phone:602-386-1100
Practice Address - Fax:602-386-1150
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19971207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ078932Medicaid
AZ078932Medicaid
20879Medicare ID - Type Unspecified