Basic Information
| Provider Information | |||||||||
| NPI: | 1689673899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEINEKE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 EASTPOINT PKWY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027534949 | ||||||||
| FaxNumber: | 5027534950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 KY HIGHWAY 36 E | ||||||||
| Address2: | |||||||||
| City: | CYNTHIANA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410317498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592342300 | ||||||||
| FaxNumber: | 8592353699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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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 | 2085R0202X | 19217 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208D00000X | 19217 | KY | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 35.030273 | OH | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 64192172 | 05 | KY | MEDICAID | 8759011 | 01 | KY | UNITED HEALTHCARE UPIN | OTHER | 000000058821 | 01 | KY | ANTHEM B/C UPIN | OTHER | C74139 | 01 | KY | BLUEGRASS FAMILY HEALTH | OTHER |