Provider Demographics
NPI:1205043361
Name:KEITH B DANIELS DPM PC
Entity Type:Organization
Organization Name:KEITH B DANIELS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-424-3338
Mailing Address - Street 1:2811 E COURT STE B
Mailing Address - Street 2:PO BOX 228
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501
Mailing Address - Country:US
Mailing Address - Phone:810-424-3338
Mailing Address - Fax:
Practice Address - Street 1:2811 E COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4054
Practice Address - Country:US
Practice Address - Phone:810-424-3338
Practice Address - Fax:810-424-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKD001100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5255005Medicare PIN
MI0581810001Medicare NSC