Provider Demographics
NPI:1649377391
Name:WHITMER, DANIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:WHITMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:L
Other - Last Name:WHITMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE #275
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-431-3700
Mailing Address - Fax:937-431-3705
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE #275
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-431-3700
Practice Address - Fax:937-431-3705
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047693W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528263Medicaid
OHA15336Medicare UPIN
OHWHO528084Medicare ID - Type Unspecified