Provider Demographics
NPI:1588631147
Name:DALY, ANNEMARIE LINDA (MD)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:LINDA
Last Name:DALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNEMARIE
Other - Middle Name:LINDA
Other - Last Name:LINARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:500 KIRTS BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4134
Practice Address - Country:US
Practice Address - Phone:248-824-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAD054293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4522040Medicaid
MI700E811600OtherBCBS GROUP PIN
MI700H249500OtherBCBS GROUP PIN
MICG3568OtherRAILROAD MEDICARE GROUP #
MI060057218OtherRAILROAD MEDICARE ID #
MICG3568OtherRAILROAD MEDICARE GROUP #
MI383429840OtherEIN
MI364615119OtherEIN
MICG3568OtherRAILROAD MEDICARE GROUP #
MI0P52570Medicare PIN
MI700H249500OtherBCBS GROUP PIN
MI700E811600OtherBCBS GROUP PIN
MI0M73900001Medicare ID - Type UnspecifiedMEDICARE MEMBER ID #
MIP52570002Medicare PIN