Provider Demographics
NPI:1275627309
Name:COURIEL, DANIEL RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICARDO
Last Name:COURIEL
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 1:2000 CIRCLE OF HOPE DR
Mailing Address - Street 2:OFFICE 2151
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5550
Mailing Address - Country:US
Mailing Address - Phone:801-213-2082
Mailing Address - Fax:
Practice Address - Street 1:2000 CIRCLE OF HOPE DR
Practice Address - Street 2:OFFICE 2151
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5550
Practice Address - Country:US
Practice Address - Phone:801-213-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095945207RH0003X, 207RX0202X, 207R00000X, 207RH0000X
UT9455685-1205207RH0003X
TN42445207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000532Medicaid
TN4156129OtherBCBS TN
TN3000532Medicaid
MIG63591Medicare UPIN
G63591Medicare UPIN