Provider Demographics
NPI:1558591990
Name:DELIGIANIS, DAN CONSTANTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:CONSTANTINE
Last Name:DELIGIANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:C
Other - Last Name:DELIGIANIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:616 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5011
Mailing Address - Country:US
Mailing Address - Phone:810-985-6933
Mailing Address - Fax:810-987-4572
Practice Address - Street 1:4170 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3702
Practice Address - Country:US
Practice Address - Phone:810-385-8752
Practice Address - Fax:810-987-4572
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042936207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology