Individual
DR. DANIEL J LIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
428 W VOTAW ST, PORTLAND, IN 47371-1302
(260) 726-8822
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01089292A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300040515
—
IN
01
—
M12240475
MEDICARE PTAN
IN
Enumeration date
07/10/2020
Last updated
10/26/2023
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