Provider Demographics
NPI:1386648061
Name:ICHEL, DANIEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALAN
Last Name:ICHEL
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2800 L STREET
Practice Address - Street 2:SUITE 610
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-733-4400
Practice Address - Fax:916-454-6926
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-00502085R0202X
CAG871542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45138Medicaid
NM2258272OtherMEDICARE GROUP
NML0634Medicaid
NM19176872Medicaid
NM600521002OtherMEDICARE IDTF
NM700521102OtherMEDICARE GROUP
NM52713Medicaid
NM800521126OtherMEDICAID IDTF
NM800521126OtherMEDICAID IDTF
NM19176872Medicaid