Healthcare Provider Details

I. General information

NPI: 1689673899
Provider Name (Legal Business Name): DANIEL D. BEINEKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 KY HIGHWAY 36 E
CYNTHIANA KY
41031-7498
US

IV. Provider business mailing address

1700 EASTPOINT PKWY SUITE 220
LOUISVILLE KY
40223-4140
US

V. Phone/Fax

Practice location:
  • Phone: 859-234-2300
  • Fax: 859-235-3699
Mailing address:
  • Phone: 502-753-4949
  • Fax: 502-753-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19217
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19217
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35.030273
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: