Provider Demographics
NPI:1912915638
Name:KOONTZ, DANIEL W (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:KOONTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7780 S BROADWAY STE 260
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2633
Mailing Address - Country:US
Mailing Address - Phone:303-730-2883
Mailing Address - Fax:303-730-2471
Practice Address - Street 1:7780 S BROADWAY STE 260
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2633
Practice Address - Country:US
Practice Address - Phone:303-730-2883
Practice Address - Fax:303-730-2471
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-0873582084N0400X
KS04-467892084N0400X
CODR.00535902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4315260OtherAETNA
OH363718OtherWELLCARE MEDICAID
OH744032OtherBUCKEYE MEDICAID
OHP00428932OtherRAILROAD MEDICARE
OH000000209908OtherUNISON
OH2672246Medicaid
OH000000503643OtherANTHEM
OH2672246Medicaid