MEDICARE: TYRONE L DANIELS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	14818	WV
2	207RC0000X	Cardiovascular Disease Physician	32841	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00837112	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043264393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE L DANIELS MD

Provider Business Mailing Address
First Line	:	8019 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-1303
Country	:	US
Telephone Number	:	502-333-3121
Fax Number	:	502-531-9538

Provider Business Practice Location Address
First Line	:	8019 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-1303
Country	:	US
Telephone Number	:	502-333-3121
Fax Number	:	502-531-9538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/11/2023

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Directions to “ TYRONE L DANIELS MD” Practice Location

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