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Individual

DR. THEMEN S. DANIELSON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
9780 LANTERN RD, SUITE 210, FISHERS, IN 46037-4092
(317) 578-4213
(317) 578-9511
Mailing address
9780 LANTERN RD, SUITE 210, FISHERS, IN 46037-4092
(317) 578-4213
(317) 578-9511

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01025278A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000383565
ANTHEM
01
01025278
IN STATE LIC NUMBER
IN
01
10781256
CAQH
Enumeration date
06/23/2006
Last updated
07/08/2007
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