MEDICARE: DAN DAUM

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	172V00000X	Community Health Worker	33.015116 C-D	OH

General Provider Information

NPI Number	:	1588022826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN DAUM

Provider Business Mailing Address
First Line	:	830 E JOHNSTOWN RD STE C
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3815
Country	:	US
Telephone Number	:	614-584-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 E JOHNSTOWN RD STE C
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3815
Country	:	US
Telephone Number	:	614-584-7989
Fax Number	:

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	02/01/2016

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Directions to “ DAN DAUM ” Practice Location

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