Provider Demographics
NPI:1598731796
Name:YANICKO, DANIEL ROBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:YANICKO
Suffix:JR
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 1:160 W STATE ROAD 32
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-8965
Mailing Address - Country:US
Mailing Address - Phone:606-416-8541
Mailing Address - Fax:
Practice Address - Street 1:163 TOWER CIR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3479
Practice Address - Country:US
Practice Address - Phone:606-679-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055175207X00000X
IN01081485A207X00000X
LA14779R207X00000X
KY41399207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6410366Medicaid
KY6410366Medicaid
KY1971701Medicare PIN
K052391Medicare PIN