Provider Demographics
NPI:1154308278
Name:DALY, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DALY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3421
Mailing Address - Country:US
Mailing Address - Phone:641-828-3832
Mailing Address - Fax:641-828-3820
Practice Address - Street 1:1208 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3421
Practice Address - Country:US
Practice Address - Phone:641-828-3832
Practice Address - Fax:641-828-3820
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02269207Q00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154308278Medicaid
IA9048942Medicaid
IA0421982Medicaid
IA080138392OtherRR MEDICARE
IA080157711OtherRR MEDICARE
IA5048942Medicaid
IA1048942Medicaid
IA6048942Medicaid
IA415300013Medicare PIN
IA0421982Medicaid
IA6048942Medicaid