Provider Demographics
NPI:1972593440
Name:BARRETT, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:BARRETT
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 1:52500 FIR RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8579
Mailing Address - Country:US
Mailing Address - Phone:574-204-7050
Mailing Address - Fax:574-204-7051
Practice Address - Street 1:52500 FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8579
Practice Address - Country:US
Practice Address - Phone:574-204-7050
Practice Address - Fax:574-204-7051
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031708A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100138880Medicaid
IN100138880Medicaid