Provider Demographics
NPI:1306838081
Name:MANN, DANIEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14734 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1927
Mailing Address - Country:US
Mailing Address - Phone:231-547-6554
Mailing Address - Fax:231-547-1179
Practice Address - Street 1:14734 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1927
Practice Address - Country:US
Practice Address - Phone:231-547-6554
Practice Address - Fax:231-547-1179
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDM076754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4218766Medicaid
MI4218766Medicaid