Provider Demographics
NPI:1336144260
Name:FARRELL, DANIEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLEN
Last Name:FARRELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:427 SEMINOLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3747
Practice Address - Country:US
Practice Address - Phone:231-739-6000
Practice Address - Fax:231-739-6004
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-03-03
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Provider Licenses
StateLicense IDTaxonomies
MI4301055295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80235Medicare UPIN