Provider Demographics
NPI:1174626303
Name:MCKIEVER, DANIEL JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:MCKIEVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:877-348-1281
Mailing Address - Fax:901-227-3206
Practice Address - Street 1:1523 22ND AVE STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4016
Practice Address - Country:US
Practice Address - Phone:601-483-0039
Practice Address - Fax:601-485-7240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS13486174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111934Medicaid
MS73069282OtherBLUE CROSS OF ALABAMA
MSE83796Medicare UPIN
MS00111934Medicaid