MEDICARE: DR. DANIEL ALAN ICHEL M.D.

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	2085R0202X	Diagnostic Radiology Physician	2002-0050	NM
2	2085R0202X	Diagnostic Radiology Physician	G87154	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2258272	OTHER	NM	MEDICARE GROUP
5	600521002	OTHER	NM	MEDICARE IDTF
6	700521102	OTHER	NM	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386648061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL ALAN ICHEL M.D.

Provider Business Mailing Address
First Line	:	10470 OLD PLACERVILLE RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2539
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 L STREET
Second Line	:	SUITE 610
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5616
Country	:	US
Telephone Number	:	916-733-4400
Fax Number	:	916-454-6926

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/22/2015

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Directions to “ DR. DANIEL ALAN ICHEL M.D.” Practice Location

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