Healthcare Provider Details

I. General information

NPI: 1265134829
Provider Name (Legal Business Name): CHRISTIAN DAAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

IV. Provider business mailing address

729 N CHESTER AVE
INDIANAPOLIS IN
46201-2624
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0275
  • Fax:
Mailing address:
  • Phone: 317-650-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11023460A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01097117A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: