Provider Demographics
NPI:1477661114
Name:ELSKENS, DANIEL P (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:ELSKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-502-8001
Mailing Address - Fax:419-502-8324
Practice Address - Street 1:703 TYLER ST STE 350
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-502-8001
Practice Address - Fax:419-502-8324
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406954207T00000X
OH35.133151207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI318161610Medicaid
OM15420001Medicare ID - Type Unspecified
MI318161610Medicaid