Healthcare Provider Details

I. General information

NPI: 1801232558
Provider Name (Legal Business Name): DANIELLE CHRISTINE CUMMINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH STREET WEST PAVILION M200
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

307 W STOP 11 ROAD
INDIANAPOLIS IN
46217
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-4260
  • Fax:
Mailing address:
  • Phone: 765-586-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number01079290A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11017044A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01079290A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: