Basic Information
| Provider Information | |||||||||
| NPI: | 1003883646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELSHOFF | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 471 MARKER RD | ||||||||
| Address2: | |||||||||
| City: | VERSAILLES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453809324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375269834 | ||||||||
| FaxNumber: | 9375269446 | ||||||||
| Practice Location | |||||||||
| Address1: | 471 MARKER RD | ||||||||
| Address2: | |||||||||
| City: | VERSAILLES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453809324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375269834 | ||||||||
| FaxNumber: | 9375269446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 11/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35069148 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2037021 | 05 | OH | MEDICAID |