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General NPI Number Information
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NPI Number | 1265426092
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Entity Type | Individual
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Provider Name | DAN LIVIU DUSLEAG MD
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Gender | Male
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3209 W REDDY WAY
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4088
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Country | US
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Telephone | 812-276-1391
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 W REDDY WAY
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01048041A
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License Number State | IN
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