MEDICARE: DR. DANIEL ALEXANDER CHARLICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	15126R	LA
2	207X00000X	Orthopaedic Surgery Physician	35090817	OH
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	35090817	OH

General Provider Information

NPI Number	:	1093705063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL ALEXANDER CHARLICK M.D.

Provider Business Mailing Address
First Line	:	4760 BELPAR ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3603
Country	:	US
Telephone Number	:	330-492-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 BELPAR ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3603
Country	:	US
Telephone Number	:	330-492-9200
Fax Number	:	330-492-5454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/18/2011

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Directions to “ DR. DANIEL ALEXANDER CHARLICK M.D.” Practice Location

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