Provider Demographics
NPI:1114669355
Name:MCDANIEL, MICHAEL SR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCDANIEL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18217 WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3555
Mailing Address - Country:US
Mailing Address - Phone:216-867-7668
Mailing Address - Fax:
Practice Address - Street 1:18217 WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3555
Practice Address - Country:US
Practice Address - Phone:216-867-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide