Provider Demographics
NPI:1801980644
Name:HILL, DANIELL (MD)
Entity type:Individual
Prefix:
First Name:DANIELL
Middle Name:
Last Name:HILL
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 1:360 AMSDEN AVE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1851
Mailing Address - Country:US
Mailing Address - Phone:859-879-2451
Mailing Address - Fax:859-402-0990
Practice Address - Street 1:360 AMSDEN AVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1851
Practice Address - Country:US
Practice Address - Phone:859-879-2451
Practice Address - Fax:859-402-0990
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26006207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000364342OtherANTHEM
KY64260060Medicaid
KY0675903Medicare PIN
KY000000364342OtherANTHEM
KY64260060Medicaid