Provider Demographics
NPI:1962496562
Name:HARRIS, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:HARRIS
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 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056155A2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00024129OtherRR MEDICARE PIN
P00024130OtherRR MEDICARE PIN
IN000000240252OtherANTHEM
IN200389470AMedicaid
IN300136447OtherRAILROAD MEDICARE
P00024091OtherRR MEDICARE PIN
P00024183OtherRR MEDICARE PIN
P00023648OtherRR MEDICARE PIN
P00024090OtherRR MEDICARE PIN
P00024126OtherRR MEDICARE PIN
P00024407OtherRR MEDICARE PIN
P00385404OtherRR MEDICARE PIN
P00024406OtherRR MEDICARE PIN
P00024089OtherRR MEDICARE PIN
P00024131OtherRR MEDICARE PIN
P00024071OtherRR MEDICARE PIN
P00023648OtherRR MEDICARE PIN
P00024091OtherRR MEDICARE PIN
P00385404OtherRR MEDICARE PIN
P00024089OtherRR MEDICARE PIN
152690OMedicare PIN