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NPI Code Detail

MEDICARE: DANIEL JOSEPH DESALLE D.O.

MEDICARE: DANIEL JOSEPH DESALLE D.O.
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
1208M00000XHospitalist Physician02003389AIN
2207R00000XInternal Medicine PhysicianOSO13829PA
3207R00000XInternal Medicine Physician02003389AIN

General Provider Information

NPI Number : 1902959026
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL JOSEPH DESALLE D.O.
Provider Business Mailing Address
First Line : 3600 W BETHEL AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-5407
Country : US
Telephone Number : 800-622-6575
Fax Number :
Provider Business Practice Location Address
First Line : 6920 GATWICK DR STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46241-9619
Country : US
Telephone Number : 317-455-1064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2007
Last Update Date : 12/30/2024

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