Provider Demographics
NPI:1184841579
Name:DANEK, IRENE S (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:S
Last Name:DANEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6438 MISSION RDG
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-6121
Mailing Address - Country:US
Mailing Address - Phone:231-946-0224
Mailing Address - Fax:231-276-7881
Practice Address - Street 1:9900 DIAMOND PARK RD
Practice Address - Street 2:
Practice Address - City:INTERLOCHEN
Practice Address - State:MI
Practice Address - Zip Code:49643-9339
Practice Address - Country:US
Practice Address - Phone:231-276-7220
Practice Address - Fax:231-276-7881
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301028968208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice