Provider Demographics
NPI:1942354808
Name:MCDANIEL, D MIKE
Entity Type:Individual
Prefix:DR
First Name:D
Middle Name:MIKE
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 GREENBRIAR DR APT A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5994
Mailing Address - Country:US
Mailing Address - Phone:870-892-8400
Mailing Address - Fax:870-892-6033
Practice Address - Street 1:153 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455
Practice Address - Country:US
Practice Address - Phone:870-892-8400
Practice Address - Fax:870-892-6033
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA84231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56313OtherARK BCBS
AR56313Medicare ID - Type Unspecified
AZP64789Medicare UPIN