Healthcare Provider Details

I. General information

NPI: 1184796039
Provider Name (Legal Business Name): DANIEL CHARLES BAXTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 HOSPITAL DR
WINAMAC IN
46996-1173
US

IV. Provider business mailing address

168 S HOWELL ST
HILLSDALE MI
49242-2040
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-2194
  • Fax:
Mailing address:
  • Phone: 586-268-8440
  • Fax: 586-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101012541
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: