Provider Demographics
NPI:1497715205
Name:STAHL, DANIEL (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STAHL
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 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-4111
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:201 CONRAD HARCOURT WAY STE A
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1157
Practice Address - Country:US
Practice Address - Phone:765-932-7591
Practice Address - Fax:765-932-7576
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ02001999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200265090BMedicaid
IN356004464OtherTAX ID
ININ02001999OtherIN LIC #
IN000000331182OtherANTHEM
IN941000SSSMedicare ID - Type Unspecified
IN200265090BMedicaid