MEDICARE: DANIEL L. HOUSE, M.D. LLC

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1992199590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL L. HOUSE, M.D. LLC

Provider Business Mailing Address
First Line	:	1000 N 16TH ST
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-4319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL HOUSE
Credential	:	M.D.
Telephone Number	:	765-521-0890

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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