Provider Demographics
NPI:1972723955
Name:MCQUILLEN, DANIEL PAUL (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:MCQUILLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S US HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9317
Mailing Address - Country:US
Mailing Address - Phone:816-532-3999
Mailing Address - Fax:816-532-4465
Practice Address - Street 1:601 S US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-9317
Practice Address - Country:US
Practice Address - Phone:816-532-3999
Practice Address - Fax:816-532-4465
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-32789207Q00000X
IA04040207Q00000X
MO2020008340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200550790CMedicaid
KS110150009Medicare PIN
KS200550790CMedicaid