Individual
DANIEL ANTHONY INDILICATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1094 S GILBERT RD, SUITE 203, GILBERT, AZ 85296-3445
(480) 882-4000
Mailing address
PO BOX 8131, SCOTTSDALE, AZ 85252-8131
(480) 882-4000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4385
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000494574001
BLUE SHIELD
NY
01
—
040511001092
FIDELIS CARE
NY
Enumeration date
07/26/2006
Last updated
04/27/2010
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