Provider Demographics
NPI:1073615373
Name:MICHAELS, DANIEL DALE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DALE
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:DPM
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 269
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-0269
Mailing Address - Country:US
Mailing Address - Phone:301-797-8554
Mailing Address - Fax:301-797-9228
Practice Address - Street 1:1150 PROFESSIONAL CT
Practice Address - Street 2:SUITE C
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5852
Practice Address - Country:US
Practice Address - Phone:301-797-8554
Practice Address - Fax:301-797-9228
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01333213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403918100Medicaid
MD403918100Medicaid
MD4996860001Medicare NSC
MDU90774Medicare UPIN