Provider Demographics
NPI:1801839808
Name:SANFORD, DANIEL KEITH (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KEITH
Last Name:SANFORD
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 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4027
Practice Address - Street 1:333 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-7712
Practice Address - Fax:270-858-4607
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108680207V00000X
MS30958207V00000X
KY36597207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370966854017Medicaid
KY10805948OtherCAQH
IL036108680Medicaid
KY64033269Medicaid
ILCF3444OtherMEDICARE RAILROAD GROUP
ILH41591Medicare UPIN
ILCF3444OtherMEDICARE RAILROAD GROUP