Provider Demographics
NPI:1598769341
Name:MAURER, DANIEL T (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:MAURER
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE 208
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-897-2440
Practice Address - Fax:502-897-2455
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24476207X00000X
IN01040374A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100355000Medicaid
KY000000694577OtherANTHEM - NOTC
KY50031099OtherPASSPORT & PASSPORT ADVANTAGE - NOTC
KY64244767Medicaid
KY121690OtherSIHO - NOTC
KY000057080YOtherHUMANA - NOTC
KY1959517OtherCIGNA - NOTC
INP00912410Medicare PIN
IN091290KMedicare UPIN
KYP400032350Medicare PIN
IN100355000Medicaid
KY64244767Medicaid
KY0562210Medicare PIN
KYP00046217Medicare PIN