Provider Demographics
NPI:1316975014
Name:SPITZBERG, DANNY H (MD)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:H
Last Name:SPITZBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:H
Other - Last Name:SPITZBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8244 E US HWY 36
Mailing Address - Street 2:#200
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-272-2020
Mailing Address - Fax:317-272-6544
Practice Address - Street 1:8244 E US HWY 36
Practice Address - Street 2:#200
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-844-5500
Practice Address - Fax:317-573-4230
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021242A207W00000X
AZ17641207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100059280Medicaid
IN000000390308OtherBC/BS #
IN100059280Medicaid
INB28230Medicare UPIN
IN000000390308OtherBC/BS #