Provider Demographics
NPI:1205879285
Name:LONEY, DANIEL LOUIS (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LOUIS
Last Name:LONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PROVIDENT DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3291
Mailing Address - Country:US
Mailing Address - Phone:574-372-5868
Mailing Address - Fax:574-372-5869
Practice Address - Street 1:1540 PROVIDENT DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3291
Practice Address - Country:US
Practice Address - Phone:574-372-5868
Practice Address - Fax:574-372-5869
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001104A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200044870Medicaid
453220IIMedicare PIN
IN200044870Medicaid
134670GMedicare PIN
IN262490LMedicare PIN