Healthcare Provider Details

I. General information

NPI: 1326535741
Provider Name (Legal Business Name): ROBERT PATRICK DAZE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR STE 101
CARMEL IN
46032-5875
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-2396
  • Fax: 317-846-1699
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number02006709A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: