Basic Information
| Provider Information | |||||||||
| NPI: | 1497715205 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAHL | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 608 | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461730608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659327591 | ||||||||
| FaxNumber: | 7659327505 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 E 13TH ST | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461732126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659327591 | ||||||||
| FaxNumber: | 7659327505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | IN02001999 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000331182 | 01 | IN | ANTHEM | OTHER | 200265090B | 05 | IN | MEDICAID | IN02001999 | 01 | IN | IN LIC # | OTHER | 356004464 | 01 | IN | TAX ID | OTHER |