Provider Demographics
NPI:1629246061
Name:DAN PILLOW, PH.D., PC
Entity Type:Organization
Organization Name:DAN PILLOW, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-299-4315
Mailing Address - Street 1:200 DIVERSION ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2267
Mailing Address - Country:US
Mailing Address - Phone:248-299-4315
Mailing Address - Fax:
Practice Address - Street 1:200 DIVERSION ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2267
Practice Address - Country:US
Practice Address - Phone:248-299-4315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003394251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0N63780Medicare PIN