Provider Demographics
NPI:1427011790
Name:RILEY, DANIEL N (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:N
Last Name:RILEY
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 1:7901 XERXES AVE S STE 116
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1200
Mailing Address - Country:US
Mailing Address - Phone:952-888-2024
Mailing Address - Fax:952-888-3985
Practice Address - Street 1:7901 XERXES AVE S STE 116
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1200
Practice Address - Country:US
Practice Address - Phone:952-888-2024
Practice Address - Fax:952-888-3985
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A95525Medicare UPIN
080006356Medicare ID - Type Unspecified