Provider Demographics
NPI:1447220678
Name:BANGART, DANIEL L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:BANGART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:L
Other - Last Name:BANGART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:STE F1
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4232
Mailing Address - Country:US
Mailing Address - Phone:623-974-0522
Mailing Address - Fax:623-933-5787
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:STE F1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4232
Practice Address - Country:US
Practice Address - Phone:623-974-0522
Practice Address - Fax:623-933-5787
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480026137OtherMEDICARE RAILROAD
AZ186206OtherAHCCCS
5059650001OtherMEDICARE NSC
AZAZ0190790OtherBLUE CROSS
AZU12172Medicare UPIN
AZZDPM345Medicare ID - Type Unspecified