Individual
DANIEL FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1520 N SENATE AVE, INDIANAPOLIS, IN 46202-2213
(317) 962-8893
(317) 962-1048
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01041566A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000363213
ANTHEM
IN
05
—
200013910
—
IN
Enumeration date
04/27/2006
Last updated
02/09/2015
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