Provider Demographics
NPI:1629115977
Name:HADLEY, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:HADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5241 US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:WATERSMEET
Mailing Address - State:MI
Mailing Address - Zip Code:49969-0009
Mailing Address - Country:US
Mailing Address - Phone:906-358-4588
Mailing Address - Fax:906-358-4588
Practice Address - Street 1:N5241 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:WATERSMEET
Practice Address - State:MI
Practice Address - Zip Code:49969-0009
Practice Address - Country:US
Practice Address - Phone:906-358-4588
Practice Address - Fax:906-358-4588
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0045562207Q00000X
MI4301111226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74226061Medicaid
CO74226061Medicaid