Healthcare Provider Details

I. General information

NPI: 1598726168
Provider Name (Legal Business Name): MAGDOLINE DAAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/27/2023
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 HILLSDALE COURT
INDIANAPOLIS IN
46250-2040
US

IV. Provider business mailing address

8180 CLEARVISTA PARKWAY SUITE 230 ATTN SHERRY MUELLER
INDIANAPOLIS IN
46256-4649
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-7740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01060436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: