Provider Demographics
NPI:1598772105
Name:DANTO, JEFFREY D (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:DANTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 DIXIE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3564
Mailing Address - Country:US
Mailing Address - Phone:248-674-4141
Mailing Address - Fax:248-674-9581
Practice Address - Street 1:4396 DIXIE HWY STE 1
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3564
Practice Address - Country:US
Practice Address - Phone:248-674-4141
Practice Address - Fax:248-674-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400208213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1863410Medicaid
MI4079448Medicaid
MI1863410Medicaid
MIT34197Medicare UPIN