Provider Demographics
NPI:1619982998
Name:CONLEY, DANIEL S (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:S
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1415 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3837
Mailing Address - Country:US
Mailing Address - Phone:330-650-2175
Mailing Address - Fax:
Practice Address - Street 1:575 WHITE POND DR
Practice Address - Street 2:SUITE D
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1184
Practice Address - Country:US
Practice Address - Phone:330-835-1629
Practice Address - Fax:330-835-3863
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001454213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145837Medicaid
OH000000036199OtherANTHEM
OH341022717OtherTAX ID NUMBER
OH341022717OtherTAX ID NUMBER
OH0145837Medicaid
OH000000036199OtherANTHEM