Provider Demographics
NPI:1629170436
Name:DANIEL, MICHAEL PAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAGE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 KIRKPATRICK RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8148
Mailing Address - Country:US
Mailing Address - Phone:336-584-1010
Mailing Address - Fax:336-584-4005
Practice Address - Street 1:1041 KIRKPATRICK RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8148
Practice Address - Country:US
Practice Address - Phone:336-584-1010
Practice Address - Fax:336-584-4005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34967174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8926955Medicaid
NC2169970BOtherPSC MEDICARE PROVIDER#
NCC36393Medicare UPIN
NC2169970EMedicare ID - Type Unspecified