Provider Demographics
NPI:1669492856
Name:DANIEL, WINDGROVE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WINDGROVE
Middle Name:DAVID
Last Name:DANIEL
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 1:248 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1204
Mailing Address - Country:US
Mailing Address - Phone:310-256-4380
Mailing Address - Fax:310-256-4381
Practice Address - Street 1:248 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1204
Practice Address - Country:US
Practice Address - Phone:310-256-4380
Practice Address - Fax:310-256-4381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41152207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50452Medicare UPIN
CAA41152Medicare ID - Type Unspecified