Provider Demographics
NPI:1932294204
Name:MCDANIEL, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:MCDANIEL
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 1:10649 BENNETT PKWY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7849
Mailing Address - Country:US
Mailing Address - Phone:317-873-6700
Mailing Address - Fax:317-873-8200
Practice Address - Street 1:10649 BENNETT PKWY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7849
Practice Address - Country:US
Practice Address - Phone:317-873-6700
Practice Address - Fax:317-873-8200
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100097000Medicaid
IN151560H4Medicare PIN
IN100097000Medicaid
INC24422Medicare UPIN
080159205Medicare PIN