Provider Demographics
NPI:1790791747
Name:CAYLOR, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 OLIO RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7237
Mailing Address - Country:US
Mailing Address - Phone:317-621-1300
Mailing Address - Fax:
Practice Address - Street 1:13121 OLIO RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7237
Practice Address - Country:US
Practice Address - Phone:317-621-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052606A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00257547OtherRR MEDICARE
IN000000358332OtherANTHEM
IN000000358332OtherANTHEM
INP00257547OtherRR MEDICARE