Provider Demographics
NPI:1972657633
Name:EMIG, DANIEL RAWN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAWN
Last Name:EMIG
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 1:3662 N WINIFRED WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-5959
Mailing Address - Country:US
Mailing Address - Phone:219-682-8738
Mailing Address - Fax:928-466-9314
Practice Address - Street 1:3662 N WINIFRED WAY
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-5959
Practice Address - Country:US
Practice Address - Phone:219-682-8738
Practice Address - Fax:928-466-9314
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063013A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00413504OtherRR MEDICARE
IN200827270Medicaid
IN655660GGMedicare PIN