Provider Demographics
NPI:1093752156
Name:MAXWELL, DANIEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W CHISHOLM STREET
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-356-8089
Mailing Address - Fax:989-356-8047
Practice Address - Street 1:1501 W CHISHOLM STREET
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707
Practice Address - Country:US
Practice Address - Phone:989-356-8089
Practice Address - Fax:989-356-8047
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009038207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG37019OtherUPIN #
MI3349315Medicaid
MI3349315Medicaid