Provider Demographics
NPI:1164486379
Name:FLETCHER, DANIEL B (BA, BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:B
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:BA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1345
Mailing Address - Country:US
Mailing Address - Phone:734-282-7991
Mailing Address - Fax:734-282-8925
Practice Address - Street 1:13123 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1345
Practice Address - Country:US
Practice Address - Phone:734-282-7991
Practice Address - Fax:734-282-8925
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002179237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4207196Medicaid
MI0H22651Medicare ID - Type Unspecified
MI4207196Medicaid