Provider Demographics
NPI:1083727200
Name:MARGO, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MARGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:520 NW 1ST AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2776
Mailing Address - Country:US
Mailing Address - Phone:218-327-7973
Mailing Address - Fax:218-327-3245
Practice Address - Street 1:1542 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-9603
Practice Address - Country:US
Practice Address - Phone:218-327-7973
Practice Address - Fax:218-327-3245
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN39379208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN274517800Medicaid
MN97B19MAOtherBCBS
MN274517800Medicaid
MN020001680Medicare PIN