Provider Demographics
NPI:1518082296
Name:JEFFREY DANTO DPM
Entity Type:Organization
Organization Name:JEFFREY DANTO DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-261-4444
Mailing Address - Street 1:29520 6 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3671
Mailing Address - Country:US
Mailing Address - Phone:734-261-4444
Mailing Address - Fax:734-261-0476
Practice Address - Street 1:29520 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3671
Practice Address - Country:US
Practice Address - Phone:734-261-4444
Practice Address - Fax:734-261-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJD400208213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4319580Medicaid
MI4596230002OtherDME ID
MIJD400208OtherLICENSE
MI4079448Medicaid
MI4079448Medicaid
MIT34197Medicare UPIN