Provider Demographics
NPI:1750432969
Name:HURLEY, DANIEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:HURLEY
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-0100
Mailing Address - Country:US
Mailing Address - Phone:317-859-1090
Mailing Address - Fax:317-941-7254
Practice Address - Street 1:6745 GRAY RD STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3236
Practice Address - Country:US
Practice Address - Phone:317-859-1090
Practice Address - Fax:317-941-7254
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029180A207RG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01029180BOtherCSR
IN000000015258OtherM PLAN
IN000000091649OtherANTHEM
IN100359320Medicaid
IN351994904OtherTAX IDENTIFICATION
IN10816013OtherCAQH
IN380000985OtherRAILROAD MEDICARE
IN380000985OtherRAILROAD MEDICARE
IN01029180BOtherCSR
IN100359320Medicaid