Provider Demographics
NPI:1861665531
Name:BROSHEARS, DANIELLE DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:DAWN
Last Name:BROSHEARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N US 31 STE B
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1546
Mailing Address - Country:US
Mailing Address - Phone:317-668-1750
Mailing Address - Fax:317-535-0952
Practice Address - Street 1:8 N US 31 STE B
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184
Practice Address - Country:US
Practice Address - Phone:317-668-1750
Practice Address - Fax:317-535-0952
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068346A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200985640Medicaid