Provider Demographics
NPI:1205517505
Name:MULAWA, DANIEL CHARLES (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHARLES
Last Name:MULAWA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-343-6562
Practice Address - Street 1:1700 DIVIDEND DR
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1572
Practice Address - Country:US
Practice Address - Phone:574-722-7407
Practice Address - Fax:574-847-7203
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
INPENDING363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical