Provider Demographics
NPI:1235100405
Name:STRICOF, DANIEL DUNN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DUNN
Last Name:STRICOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 N VIA FRASSINO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-5979
Mailing Address - Country:US
Mailing Address - Phone:520-289-6886
Mailing Address - Fax:
Practice Address - Street 1:5441 N VIA FRASSINO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-5979
Practice Address - Country:US
Practice Address - Phone:520-289-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ179662085N0700X, 2085R0202X, 2085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ281642Medicaid
AZ1235100405OtherPHYSICIAN INDIVIDUAL NPI
AZ300024061OtherMEDICARE RAILROAD
AZ1841261989OtherGROUP NPI
AZ005472OtherGROUP MEDICAID ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZZWCBBMOtherGROUP MEDICARE ID
AZ005472OtherGROUP MEDICAID ID
AZZ30WCBBM26Medicare PIN